Peptic ulcers are open sores include : Gastric ulcers  Esophageal ulcers  Duodenal ulcers Perforation Bleeding Penetration Maliginization Obstruction

1. COMPLICATIONS OF PEPTIC ULCER DISEASE
DONE BY : MUSTAFA KHALIL IBRAHIM
TBILISI STATE MEDICAL UNIVERSITY
4th year, 1st semester, 2nd group

2. ANATOMY & PHYSIOLOGY

3. PEPTIC ULCER
 Peptic ulcers are open sores
include :
 Gastric ulcers
 Esophageal ulcers
 Duodenal ulcers

4. MORBIDITY
100
30
1 2
Surgical Treatment Before and After PPI (%)
The number of elective operations for peptic ulcer disease
dropped more than 70% in the 1980s;
80% of these procedures were emergent operations

5. CAUSES
 H. pylori infections are now uncommon.
 (NSAIDs).
 Smoking, alcohol.
 Mental stress.
 Genetics.
 This is because these types of ulcers do not
always cause obvious symptoms, so are left
untreated.
 It is estimated that around 1 in 50 people with
a NSAID-related stomach ulcer will develop a
complication.

6. SYMPTOMS OF COMPLICATED PUD
sudden, sharp pain that doesn’t stop
black or bloody stools
bloody vomitus
vomit that looks like coffee grounds

7. COMPLICATIONS OF PUD
1. Perforation
2. Bleeding
3. Penetration
4. Maliginization
5. Obstruction

8. PEPTIC ULCER PERFORATION
 It affects around 1 in 350 people with a stomach ulcer.
 Annual incidence of ulcer perforation is 4 to 14 cases per 100,000
individuals
Pneumoperitoneum

9. SURGICAL TREATMENT OF PERFORATION

10. VAGOTOMY

11. BLEEDING FROM PEPTIC ULCER
 Melena
 Tachycardia
 Hypotension
Main possible reasons:
 Peptic ulcer;
 Gastritis;
 Portal hypertension
Stops spontaneously in 75%.
Reminder will require surgery or
die;

12. BLEEDING FROM PEPTIC ULCER
 Peptic ulcer hemorrhage is on the order
of 19 to 57 cases per 100,000 individuals
 Internal bleeding is the most common
complication of stomach ulcers. Internal
bleeding can occur when an ulcer
develops at a site of a blood vessel. You
are at an increased risk of bleeding if
you:
 are on continued use of non-steroidal
anti-inflammatory drugs (NSAIDs)
 are 60 years old or over

13. PENETRATION OF PEPTIC ULCER

14. MALIGNIZATION OF PEPTIC ULCER

15. GASTROECTOMY

16. OBSTRUCTION BY PEPTIC ULCER
Symptoms:
• Vomiting – Usually right after eating,
yellow or green. contains foods eaten more
than 12 hours earlier.
• Epigastric pain
• Constipation
• Loss of weight
• Hypokalemia and metabolic acidosis –
Due to vomiting.
• Hypertrophy of stomach muscles

17. PEPTIC ULCER SURGICAL COMPLICATIONS
 A. Early complications
 Duodenal stump leakage;
 Hemorrhage
 B. Late complications
 Recurrent ulcer
 Gastrojejunocolic and gastrocolic fistula
 Dumping syndrome (cardio-vascular and gastro-intestinal
symptoms). Shortly after eating palpitations, sweating,
weakness, flushing, nausea, vomiting, diarrhea etc.
 Anemia: iron deficiency anemia develops in 30% within 5 years
after gastrectomy;
 Postvagotomy diarrhea.
 Chronic gastroparesis

18. REFERENCES
 http://www.mayoclinic.org/diseases-conditions/peptic-
ulcer/basics/treatment/con-20028643
 Current Surgical Diagnosis and Treatment. A Lange Medical
Book. 12th edition, Edited by G. Doherty and L. Way. 2006.
pp:508-538.
 https://www.google.ge/search?q=Penetration+of+Peptic+Ulcer&so
urce=lnms&tbm=isch&sa=X&ved=0ahUKEwim75eNmbrNAhWCj
ywKHYG9AKsQ_AUICCgB&biw=1366&bih=599#tbm=isch&q=pe
ptic+ulcer+&imgdii=Zs1jluqdcC6e6M%3A%3BZs1jluqdcC6e6M%
3A%3BkT0uGJniXot5TM%3A&imgrc=Zs1jluqdcC6e6M%3A

21.  Lansoprazole
 Amoxicillin
 Claritromycin
 H2 receptor antagonists
 Proton pump blockers
 Antacids