6. Peptic ulcer diseases

Question 1

Peptic ulcer diseases defined as ?

Answer 1

A circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by Helicobacter pylori infection.

Question 2

EPIDEMIOLOGY of PUD ?

Answer 2

• PU up to 10%.
• Duodenal ulcers 4x more common than gastric ulcer. (mainly in the duodenal cup).
• Gastric ulcers mostly in lesser curvature of the stomach.

Question 3

HELICOBACTER PYLORI ?

Answer 3

• Most common infection in the world (20%).

- The bacterium persists in the stomach for decades in most people.

Question 4

CLASSIFICATION OF PU ?

Answer 4

– Stomach- gastric ulcer; usually antrum lesser curvature, anterior and posteriori wall
– Duodenum- duodenal ulcer- first portion, anterior wall
– Esophagus- esophageal ulcer
– Meckel’s Diverticulum ulcer
– In the margins of a gastroenterostomy- stomal ulcer
– In the duodenum, stomach or jejunum in Zollinger- Ellision syndrome

Question 5

Which classification used for PU typing ?

Answer 5

Modified johnson classification

Question 6

Modified johnson classification ? TYPE I ?

Answer 6

• TYPE I ulcer along the lesser curve of stomach

Question 7

Modified johnson classification ? TYPE 2 ?

Answer 7

• TYPE II two ulcers present- one gastric, one duodenal/ preyploric

Question 8

Modified johnson classification ? TYPE 3 ?

Answer 8

• TYPE III prepyloric ulcer

Question 9

Modified johnson classification ? TYPE 4 ?

Answer 9

• TYPE IV proximal gastroesophageal ulcer

Question 10

Modified johnson classification ? TYPE 5 ?

Answer 10

• TYPE V anywhere – associated with chronić NSAID use

Question 11

Manifestations of PU ?

Answer 11

• Episodes of remission and exacerbation.
• Pain that for duodenal ulcers is often relieved by eating or antacids.
• G.I. bleeding and possible hemorrhage (20 to 25% of patients).
• Perforation of ulcers with significant mortality.
• Obstruction of G.I. tract.

Question 12

SYMPTOMS of PU?

Answer 12

_Pain: ”gnawing”, “aching”, or “burning”.

• Duodenal ulcers: occurs 1-3 hours after a meal and may awaken patient from sleep. Pain is relieved by food, antacids, or vomiting.
• Gastric ulcers: food may exacerbate the pain while vomiting relieves it.
#_Nausea, vomiting, belching, dyspepsia, bloating, chest discomfort, anorexia, hematemesis, &/or melena may also occur.

Question 13

PUD - DIAGNOSIS
 ?

Answer 13

• Endoscopy
• Barium meal – contrast x-ray
• Biopsy – bacteria & malignancy
• H.Pylori:
  ▪ Endoscopy cytology.
  ▪ Biopsy – Special stains.
  ▪ Culture - difficult.
  ▪ Urease Breath test.

Question 14

GASTROINTESTINAL BLEEDING ?

Answer 14

• Most common complication.
• Sudden large bleeding can be life-threating.
• It occurs when the ulcer erodes one of the blood vessels.

Question 15

PERFORATION ?

Answer 15

• one of PUD complications.
  • Perforation -> acute peritonitis: chemical -> bacterial.
  • First sign is often sudden intense abdominal pain.
  • Perforation of the posterior wall can also lead to pancreatitis; pain in this situation often radiates to the back.

Question 16

SURGERY of PUD ?

Answer 16

• People who do not respond to medication, or who develop complications:

1. Vagotomy.
2. Antrectomy.
3. Pyloroplasty.

• A vagotomy is usually done in conjunction with an antrectomy.