1. PEPTIC ULCER
It means ulcer in those parts of gut which are
exposed to acid. Duodenum and stomach are
the most common sites. It can also occur in
lower osophagus.
Peptic ulcer is supposed to occur, either due to
increased acid secretion(duodenal ulcer) or
decreased mucosal resistance (gastric ulcer) or
both. Two important etiological factors are

2. • Infection by a bacterium (Helicobacter pylori)
and NSAID ingestion. Zollinger Ellison syndrome
is an uncommon cause of peptic ulcer.
• In about 1/3 cases of peptic ulcer non of the
above etiological factor is present.
• There are multiple theories how H.pylori causes
peptic ulcer. In patient of gastric ulcer there is
gastritis involving whole of the stomach,
resulting in impaired mucosal resistance.
• In duodenal ulcer patients there is antral
gastritis and loss of somatostatin secreting “D

4. • “D Cells”which normally inhibit gastric secretion;
end result is increased gastrin secretion and
increased gastric acid output. This in tern causes
injury to the duodenal mucosa.
• NSAID induce ulcer due to inhibition of
prostaglandins synthesis essential for normal
mucosal defense.
• Mechanism of ulcer not associated with H.Pylori
or NSAID ingestion is not known.
• Peptic ulcer pain is felt in the epigastrium and is
well localized. Patient point with one finger to
the site of pain- “the pointing finger”.

6. • DUODENAL ULCER;
it occurs in the first part of the duodenum.
Symptoms;
• pain is aggravated by empty stomach (hunger
pain )and is relived by food and antacids.
• Some times patient wake up after midnight due
to pain. These nocturnal pain occurs because
acid output is maximum at that time.
• Pain which is present early in the morning is not
due to peptic ulcer.

8. • History of periodicity may be present (patient
gets pain for days to weeks and then there is no
pain for weeks to months without any
treatmet).
Signs;
• There is localized tenderness in the
epigastrium.
Investigations ;
• Barium meal shows duodenal deformity.
• Endoscopy confirms the presence of ulcer.

10. GASTRIC ULCER;
Symptoms;
• Relation of pain to meals and timing is variable.
• It may be relived or aggravated by food.
• Nocturnal pain is uncommon.
Signs;
Epigastric tenderness is usually present.
Investigations;
• Barium meal shows the ulcer crater.
• Endoscopy confirms the presence of ulcer.

11. • Every gastric ulcer must be biopsied to exclude
malignancy.
COMPLICATIONS OF PEPTIC ULCER;
1- Bleeding
2- Perforation
3- Chronicity
4- Gastric outlet obstruction