This presentation is about peptic ulcer disease , including:Pathomorphology,etiology,symptoms,complications,diagnosis and pharmacotherapy,asurgical intervention and prevention...

1. Peptic Ulcer Disease
By:Rezhwan Omer Jwamer
University Of Sulaimani

2. • Introduction
• Pathomorphology
• Etiology
• Symptoms
• Complications
• Diagnosis Pharmacotherapy
• surgical intervention
• Prevention
Objectives:

3. Introduction
• Terminologically:-
• Peptic Ulcer ( “Peptikos” able to digest & “Ulcus” a sore ).
• Definition:-
• Ulcers are open sores that develop on the lining of the :
• 1-Esophagus(esophageal ulcers)
• 2-Stomach (gastric ulcers)
• 3-First part of the small intestine-Duodenum(duodenal ulcers)

4. 0
17.5
35
52.5
70
0-2
3-18
19-60
Male Female
Ages Affected

5. Peptic ulcer disease affects about 4.6
million people annually.

6. Phathomorphology

7. Etiology
• (20th Century)
• Ulcers are believed to be caused
by stress and dietary factors.
• – 1982
• Australian physicians Robin
Warren and Barry Marshall first
identify the link between (H.pylori
and ulcers).

9. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
-Are the second most common causes of “Peptic ulcers”.
-They are a class of drugs that provides analgesic (pain-killing) and antipyretic
(fever-reducing)
-Such as (aspirin , Ibuprofen, Diclofenac , Naproxen …. )
-When used for weeks or months, NSAIDs can damage the lining of the digestive
tract, causing an ulcer or making an existing ulcer worse.

11. Symptoms
11

12. • Symptoms of gastric ulcer disease:
• epigastric pain after meal or during meal
• upper dyspeptic syndrome – loss of appetite, nausea, vomiting,
flatulence
• vomiting brings relief
• reduced nutrition
• loss of weight
• The pain may radiate to the back if it has penetrated posteriorly.
• Gastric ulcer pain is aggravated by meals.

13. • Symptoms of duodenal ulcer disease:
• epigastric pain 2 hours after meal or on a empty stomach or during
night
• pyrosis
• good nutrition
• obstipation
• seasonal dependence (spring, autumn)
• Duodenal ulcer is relieved by meal.

14. Complications
• Internal bleeding:most common,occurs when an ulcer
develops at a site of a blood vessel, and can causes
anemia
• Perforation: Rare(It affects around 1 in 350),causes
peritonitis
• Gastric outlet obstruction: uncommon,(It affects around 1
in 1,000)

15. Bleeding
Perforation
Obstruction

16. Diagnosis
Radiological Diagnosis:
By using Barium X-ray or Upper GI series.
Upper GI series (UGI): This is a type
X-ray. The patient is given a chalky
liquid to drink that increases the
contrast on the X-ray, making certain
features easier to see.

17. Endoscopic
Diagnosis
flexible tube with a tiny
camera on the end. The
patient is given a mild
sedative,and then the tube
is passed through the
mouth into the stomach

18. Pharmacotherapy
1. Antibiotic medications to kill H. pylori.
• Such as :tetracycline,metronidazole(Flagyl), evofloxacin …

19. 2- Medications that block acid production and promote healing.
• Proton pump inhibitors reduce stomach acid by blocking the action of the parts
of cells that produce acid.
• such as omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex),
esomeprazole (Nexium) and pantoprazole (Protonix)

20. 3-Medications to reduce acid production.
• Acid blockers — also called histamine (H-2) blockers
• reduce the amount of stomach acid released into your digestive tract
• such as ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet) and
nizatidine (Axid).

21. 4-Antacids that neutralize stomach acid.
Antacids can provide symptom relief.

22. 5-Medications
that protect the
lining of your
stomach and
small intestine.
• include
sucralfate
(Carafate)
and
misoprostol
(Cytotec).

23. Surgical intervention
• reason for surgical intervention is the failure of medical therapy
• we have three types of surgery for peptic ulcer:
1. vagotomy.
2. Antrectomy and truncal vagotomy
3. pyloroplasty

24. Vagotomy

25. Antrectomy

26. pyloroplasty

27. Prevention
• Peptic ulcers can be prevented by avoiding
• alcohol
• smoking
• NSAID’s (aspirin)
• and caffeine.
• to avoid H.pylori you should avoid contaminated water and food