Simple explanation

1. Peptic ulcer
Dr Urmila Aswar

3. Start with the basic
anatomy
Parietal cells-HCl
Chief cells- pepsinogen
Endocrine cells- Gastrin, CCK, histamine

5. • Phases of gastric juice secretion.

6. Proglumide
ACh
PGE2
Histamine
Gastrin
Adenyl
cyclase
_
+
ATP cAMP
Protein Kinase
(Activated)
Ca++
+
Ca++
Proton pump
K
K+ H+
Gastric acid
Parietal cell
Lumen of stomach
Antacid
Omeprazole
Ranitidine
H2
M3
Misoprostol
_
_
_
_
+
PGE
receptor
+
+
Gastrin
receptor
+
+
+

7. Peptic ulcer
• Defect of mucosa related to the action of acid
and pepsin in the gastric juice. Ulcers affect
mucosa, submucosa and muscularis propria.
• Mostly in duodenum, less in stomach and very
less in esophagus or jejunum.
• Happens when gastric juice (HCl and pepsin)
is increased or defensive mechanism of mucus
is decreased.

8. Etiology
• Psychological stress
• Physiological stress: shock, severe trauma, septicaemia,
extensive burns, drug intake, Local irritants- alcohol,
coffee, smoking
Pathogenesis
• Reduction in production of bicarbonate
• Reduced production of Pgs: NSAIDS
• Increased acid production: Gastrin. Zollinger-Ellison
syndrome
• Helicobacter pylori infection: stimulates acid secretion
and inhibits bicarbonate production

9. Types
• They include gastric ulcers (those found in the
stomach) and duodenal ulcers (those that are
located in the top of the small intestine or
duodenum).
• Peptic ulcers are common and usually occur
singly. But it is possible to have two or more, or
even both duodenal and gastric ulcers at the
same time.
• Duodenal ulcers are more common than gastric
ulcers.

10. Symptoms: Gastric ulcers
• Gastric ulcer pain may be less severe than duodenal
ulcer pain and is noticeably higher in the abdomen
• Eating may increase pain rather than relieve pain
• Pain is described as aching, nagging, cramping or dull
• Other symptoms may include nausea, vomiting and
weight loss
• Occasional painless bleeding, anemia (low blood
count), or the passage of black, tarry stool may be the
first sign of peptic ulcer disease.
• Some ulcers may produce no symptoms at all.

11. Symptoms: Duodenal ulcers
• Pain that awakens patients from sleep
• Burning or gnawing sensation in the upper
abdomen
• Pain in the back, lower abdomen or chest
area may occasionally occur
• Pain that occurs when the stomach is empty
(about two hours after a meal or during the
night).
• Relief frequently occurs after eating

12. Complications of ulcers
• Obstruction: Healing of ulcer produces
obstruction called as stenosis.
• Eg Pyloric stenosis and duodenal stenosis
• Hemorrhage: minor bleeding by erosion of
small blood vessels in the base of ulcer.
• Perforation: occurs in duodenal ulcers. The
content escape from perforation into
peritoneum leading to Peritonitis.

13. Clinical features
• Age: 50 yrs
• Stressed people ..leaders executives: DuoU
Labor Group: GasU
• Periodicity: 2-6 weeks
• Pain: GasU: epigastric pain occurs within 2 hrs
• DuoU: Severe, during late night.
• Vomiting: GasU
• Haematemesis and malaena:
• Appetite: GasU: afraid to eat, DuoU: good appetite.
• Weight loss: GasU: common, DuoU: gain

14. HOW ARE PEPTIC ULCER DIAGNOSED
• Patient’s symptoms.
• Gastric function test: secretion of acid in stomach is
monitored—Basal acid output (BAO) without stimulus
and maximal acid output (MAO) under the influence of
stimulus. Reading in mEq/L.
• Stimulus used : Histamine (0.04 mg/kg bwt),
Pentagastrin etc.
• Tests for mucus: 1.8 mg/ml
• Serum gastrin level
• Test for IF
• Endoscopy

15. Complications
• Bleeding: iron deficiency anemia, pernicious
anemia
• Perforation: peritonitis
• Penetration: Duodenal ulcer penetrating into
pancreas
• Stenosis: Fibrosis that develops in the wall of
the pyloric channel of the duodemum may
cause narrowing of the lumen. It is associated
with the food retention and vomiting

16. Treatment
1. Ulcercoating agents: Sucralfate.
2. Acid neutralising agents: antacids.
3. Medications – medications that decrease the
amount of acid produced by the stomach are used
to provide quick pain relief and promote rapid
healing. Eg antihistaminics: H2 blockers: ranitidine,
cimetidine
4. Proton pump inhibitors: Inhibits H+K+ATPase present
on gastric parietal cell: Omeprazole, lansoprazole
5. Ulcer healing drugs: Pgs analogue, proglumide
6. Antibiotics: tetracycline, amoxycillin used with PPI
or ulcer protectives

17. Precautions
• Aspirin and anti-inflammatory products
should be avoided.
• Medicine to be taken regularly.