Peptic Ulcer PDF - Dr.Sarah latif kazem

Peptic ulcer Dr.Sarah latif kazem Peptic ulcers are most commonly located in the stomach or duodenum, but can also occur in the lower oesophagus.. Ulcers in the stomach or duodenum may be acute or chronic; both penetrate the muscularis mucosae, but the ac...

Peptic ulcer Dr.Sarah latif kazem Peptic ulcers are most commonly located in the stomach or duodenum, but can also occur in the lower oesophagus.. Ulcers in the stomach or duodenum may be acute or chronic; both penetrate the muscularis mucosae, but the acute ulcer shows no evidence of fibrosis. peptic ulcer consist of gastric and duodenal ulcer. Gastric and duodenal ulcer ‫ﻣﻌﺪل اﻧﺘﺸﺎر اﳌﺮض ﻣﺪى اﻟﺤﻴﺎة‬ The lifetime prevalence of peptic ulcer is around 5%–10%. The incidence is decreasing in many high-income societies as a result of widespread use of Helicobacter pylori eradication therapy. The male-to-female ratio for duodenal ulcer varies from 5:1 to 2:1, while that for gastric ulcer is 2:1 or less. Cause: Helicobacter pylori NSAIDs Smoking Clinical feature: Peptic ulcer disease is a chronic condition with spontaneous relapses and ‫ﺷﻔﺎءات ﺗﺴﳣﺮ ﻟﻌﻘﻮد ﻣﻦ اﻟﺰﻣﻦ‬ ‫اﻟﻌﺮض اﻷﻛﱶ ﺷﻴﻮﻋﺎ‬ remissions lasting for decades, if not for life. The most common presentation is with recurrent abdominal pain that has three notable characteristics:.‫ اﻟﻌﻼﻗﺔ ﺑﺎﻟﻄﻌﺎم واﻟﺤﺪوث اﳌﺘﻜﺮر‬،‫اﳌﻮﻗﻊ ﰲ اﳌﻨﻄﻘﺔ ﻓﻮق اﳌﻌﺪة‬ localisation to the epigastrium, relationship to food and episodic occurrence. Occasional vomiting occurs in about 40% of ulcer subjects; persistent daily vomiting suggests gastric outlet obstruction. In this situation, pain may be absent or so slight that it is experienced only as a vague sense of epigastric unease. Occasionally, the only symptoms are ‫ﻓﻘﺪان اﻟﳪﻴﺔ واﻟﻐﺜﻴﺎن‬ anorexia and nausea, or early satiety after meals. In some patients, the ulcer is completely ‘silent’, presenting for the first time with anaemia from chronic undetected blood loss, as abrupt haematemesis or as acute perforation; in others, there is recurrent acute bleeding without ulcer pain. Investigations Endoscopy is the preferred investigation Gastric ulcers may ‫ﺧﺒﻴﺚ‬ ‫ﻳﱲ أﺧﺬ ﺧﺰﻋﺔ ﻣﻨﻪ‬ occasionally be malignant and therefore must always be biopsied and followed up to ensure healing. Patients should be tested for H. pylori infection. Some are invasive and require endoscopy; others are non-invasive. They vary in sensitivity and specificity. Breath tests or faecal antigen tests are best because of accuracy, simplicity and non-invasiveness. Management The aims of management are to relieve symptoms, induce healing and prevent recurrence. H. pylori eradication is the cornerstone of therapy for peptic ulcers, as this will successfully prevent relapse and eliminate the need for long-term therapy in the majority of patients: 1-H. pylori eradication 2-General measures Cigarette smoking, aspirin and NSAIDs should be avoided. Alcohol in moderation is not harmful and no special dietary advice is required. 3-Surgical measure. Indications for surgery in peptic ulcer 1-Emergency  Perforation  Haemorrhage 2-Elective  Gastric outlet obstruction  Persistent ulceration despite adequate medical therapy  Recurrent ulcer following gastric surgery. Complications of peptic ulcer disease 1-Perforation 2-Gastric outlet obstruction