Peptic Ulcer PDF - 2023

Gastrointestinal diseases ❑ Gastro- Esophageal reflux disease ❑ Gastritis ❑ Peptic/gastric ulcer ❑ Gall bladder and pancreas diseases ❑ Constipation ❑ Diarrhea ❑ short bowel ❑ Irritable Bowel Syndrome ( Crohn's disease) Prof. Dr. Naeem Rabeh 2023 Peptic/gastric...

Gastrointestinal diseases ❑ Gastro- Esophageal reflux disease ❑ Gastritis ❑ Peptic/gastric ulcer ❑ Gall bladder and pancreas diseases ❑ Constipation ❑ Diarrhea ❑ short bowel ❑ Irritable Bowel Syndrome ( Crohn's disease) Prof. Dr. Naeem Rabeh 2023 Peptic/gastric Ulcer Prof. Dr. Naeem Rabeh 2023 Prof. Dr. Naeem Rabeh 2023 Peptic ulcer: localized erosion of the lining mucosa (stomach - duodenum or the lower end of the esophagus), which increases the secretion of acidic juices from the stomach. Prof. Dr. Naeem Rabeh 2023 Prof. Dr. Naeem Rabeh 2023 It is the loss of part of the lining surface of the stomach wall, which leads to the exposure of the tissues of this part to gastric juice. Although gastric juice contains burning HCL and digestive enzymes, it also contains a mucous fluid that coats the inner surface of the stomach and protects it from the effect of this acid and enzymes, as well as protects it from the harmful effect of some substances in the food itself, such as pepper and chili Prof. Dr. Naeem Rabeh 2023 What types of ulcers? Ulcers are of two types, either benign or malignant. ❑ Benign ulcers ‫قرحة حميدة‬: result from an increase in the level of HCL secretion in the stomach, and these ulcers respond easily to treatment. ❑ Malignant ulcer,‫ قرحة خبيثة‬it can occur due to the presence of a malignant tumor in the stomach, and this ulcer can respond to treatment at first, but then resist it, so treatment requires surgery. Prof. Dr. Naeem Rabeh 2023  symptoms - Feeling of pain in the middle of the abdomen (back and front) and a burning sensation in the chest‫في فم المعدة‬ where: ❑ It starts 2-3 hr. after meals. ❑ It appears in the middle of the night when the stomach is empty. ❑ Immediately after eating if the meal is large. - Blackening of stool color (for blood in stool in advanced stages) - Acid vomiting (stinging, Rabeh 2023 ‫الذع‬ Prof. Dr. Naeembloody) There are other symptoms of gastric ulcers: ❑ lost weight. ❑ Not feeling the pleasure of eating ❑ Nausea. ❑ Feeling of pain while eating ❑ Feeling of tiredness in the stomach. ❑ Burping ‫التجشؤ‬ The appearance of any of these symptoms means that you have a stomach ulcer, and you must go to the doctor. Prof. Dr. Naeem Rabeh 2023 If the above symptoms appear, the patient should go to the doctor, and he may do the following: ❖ X-rays of the stomach and duodenum. ❖ Diagnostic endoscopy: Using a thin, lighted tube with a tiny camera at its end, to see inside the stomach and duodenum. The doctor gives a drug that gives a sense of relaxation so that he can pass this tube through the mouth until it reaches the stomach and duodenum. The doctor may extract a tiny piece of the stomach for examination under the microscope, and this process is called biopsy. Prof. Dr. Naeem Rabeh 2023  Complications ✓ red hematemesis ‫قىء دموي‬ ✓ Blood (dark red) in the stool. ✓ black stools ✓ It may cause anemia where there are not enough red blood cells to transport oxygen through the body Prof. Dr. Naeem Rabeh 2023  Causes 1- An increase in the secretion of HCL in the stomach, the increase of which leads to the breaking of its wall, as well as the lack of tissue resistance to gastric juices. 2- Helicobacter pylori, which infects the body as a result of drinking contaminated water Prof. Dr. Naeem Rabeh 2023  Causes 3- Smoking has a dangerous effect on stomach ulcers, as smoking (1) increases the secretion and concentration of stomach acid, doubling the risk of developing ulcers, (2) delaying the healing of ulcers during treatment. 4- Some medications such as aspirin, sedative (‫(المسكنات‬ especially when taken on an empty stomach, weaken the ability of the stomach tissue to heal and lead to inflammation of the lining of the stomach and small intestine. Prof. Dr. Naeem Rabeh 2023 5- Alcoholic drinks lead to irritation and erosion of the stomach wall, causing ulcers 6- Excessive consumption of coffee - heavy tea - salt - chili - pepper - pickles. 7- Continuous stress - the body does not get enough rest. 8- Extreme emotions (anger - sadness) Prof. Dr. Naeem Rabeh 2023  Treatments 1- Complete rest, whether physical, psychological or mental, and away from nervousness and tension. 2- Drug or surgical treatment 3- Food therapy. Prof. Dr. Naeem Rabeh 2023  Drugs ❖ It prevents the stomach from producing acids ❖ Antacid ❖ Antibiotics to kill bacteria Drugs ❖ Reduce stomach motility and calm the nerves Stomach ulcers may reappear if you stop taking antibiotics suddenly: (1) Not all bacteria are eliminated and ulcers are not completely healed, (2) If you continue to smoke or take anti-inflammatory drugs, gastric ulcers may reappear Prof. Dr. Naeem Rabeh 2023  The role of surgery in the treatment of stomach ulcers Surgical operations are performed if the stomach ulcer: - - Don't fall asleep. - Come back again. - It spreads and causes bleeding. In this case, the surgery will lead to:- Removal or excision ‫ استئصال‬of the ulcer. Reducing the amount of acid produced by the stomach Prof. Dr. Naeem Rabeh 2023  Dietary treatments Proteins increase the secretion of gastric juice. But milk is the least effective in activating the secretion process Proteins RDA: 0.8 g/kg of ideal weight 1-1.5 g/kg of ideal weight (in case of bleeding) ‫تعويض اي نقص في امتصاص الفيتامينات والمعادن‬ )‫ الزنك‬،‫ الكالسيوم‬،‫ الحديد‬،12‫باستخدام مكمالت ( ب‬ ‫تابع‬ Prof. Dr. Naeem Rabeh 2023  Dietary treatments Fats Inhibits the secretion of gastric juice covers the ulcerated part of the stomach and prevents the effect of digestive juices Milk + butter mixture 120 g / hour or two Whole milk or skimmed milk without butter may be used ‫تابع‬ Prof. Dr. Naeem Rabeh 2023  It does not affect gastric juice. Therefore, you Carb. must eat enough carbohydrates in order to obtain the required calories Volume Gives small meals at intervals of diet As the expansion of the stomach increases the secretion of gastric acid * Alcoholic drinks and aspirin: destroy the mucous Stimulant membrane of the stomach Prof. Dr. Naeem Rabeh 2023  Drinks containing a PH less than 4 are prohibited. Beverages orange juice (it may be beneficial or harmful, depending on the patient’s condition. Meat or poultry soup is prohibited. Fibers Avoid foods containing fiber - seeds - peels Prof. Dr. Naeem Rabeh 2023  ‫األغذية المسموح بها واألغذية الممنوعة لمرضى القرحة‬ ‫األطعمة الممنوعة‬ ‫األطعمة المسموحة‬ ‫‪ -‬اللبن الزبادي واألجبان القديمة والمعتقة‪.‬‬ ‫‪ -‬اللبن ‪-‬الجبن القريش‪.‬‬ ‫‪ - -‬البيض المسلوق نصف سلق (البرشت)‪ -.‬البيض المسلوق جيداً ‪.‬‬ ‫‪ -‬اللحوووووووووة المحموووووووومل والمد نووووووووة والمملحووووووووة‬ ‫‪ -‬الزبد والقشدة والزيوت النباتية‪.‬‬ ‫المحمص أو التوست األبيض الطري‪ -‬والمصنعة والمعلبة ‪.‬‬ ‫‪ -‬الخبز‬ ‫شامي ‪.‬‬ ‫‪ -‬البسكويت العادي والكعك الجاف غير الدسم ‪ -‬الحبووووووا ال االوووووة والووووومدل وال بوووووز األ ووووومم‬ ‫‪ -‬شوربة الخضار والجزر والبطاطس والكوسة والجاف‪.‬‬ ‫‪ -‬أنواع الحسوا الد وو وال اب وا والصلصوات‬ ‫‪ -‬الخضروات (البطاطس‪ ،‬البسلة‪ ،‬الجزر‬ ‫المتبلة والممكزل‪.‬‬ ‫البطاطا ‪ ،‬الكوسة ‪ ،‬السبانخ) مسلوقة‬ ‫‪ -‬كووول ال اوووموات فووول الحالوووة الني وووة والبصووول‬ ‫ومهروسة‪.‬‬ ‫والثوووووة وال منووووا والقوووومنبيل وال يووووا وال موووواطو‬ ‫‪ -‬الفواكه المسلوقة مثل الخوخ والتفاح‬ ‫والكمثرى والمشمش (تكون مطهيه بدون والفلفل األ ام والفجل واللفت وال س ‪.‬‬ ‫‪ -‬البقوليوووووات (الفاصووووووليا والحمووووو والعووووود‬ ‫قشور أو بذور)‬ ‫غل)‪.‬‬ ‫‪Dr.‬البم‬ ‫‪Prof.‬‬ ‫‪ Naeem‬و‬ ‫‪Rabeh‬البسلة‬ ‫‪ 2023‬و‬  ‫تابع‬ ‫‪-‬األطعمة الممنوعة ‪:‬‬ ‫األطعمة المسموحة ‪:‬‬ ‫‪ -‬المخلالت ومركزات الطماطم والزيتون‬ ‫الموز الطازج‬ ‫والتوابل والخردل والخل والمايونيز‪.‬‬ ‫‪ -‬المهلبية والبودنج والكاسترد‬ ‫‪ -‬الفواكه المجففة (التين‪ ،‬القراصيا الزبيب‪،‬‬ ‫‪ -‬الجيلى والمربى ‪.‬‬ ‫المشمشية‪ ،‬جوز الهند)‪.‬‬ ‫‪ -‬اللحوم ولحم الدجاج المطهو جيدا ‪.‬‬ ‫‪ -‬الشيكوالته والحلوى‪.‬‬ ‫‪ -‬السكريات والعسل األسود وعسل‬ ‫‪ -‬المثلجات‪.‬‬ ‫النحل‪.‬‬ ‫‪ -‬األطعمة والمشروبات شديدة البرودة أو‬ ‫‪ -‬األرز المطهى‪.‬‬ ‫السخونة‪.‬‬ ‫‪ -‬الكيك الطرى‪.‬‬ ‫‪ -‬الشاى والقهوة ‪.‬‬ ‫‪ -‬البروكلى (مسلوقا)‬ ‫‪ -‬المشروبات الغازية والمشروبات الكحولية‪.‬‬ ‫‪ -‬األطعمة المقلية والمحمرة والمسبكة‪.‬‬ ‫‪Prof. Dr. Naeem Rabeh 2023‬‬  ‫توزيع وجبات المرحلتين الثانية والثالثة لمرضى القرحة‬ ‫الحادة على مدار اليوم‬ ‫كوب لبن بقري‬ ‫الساعة الثامنة صباحا‬ ‫بيضة مسلوقة (برشت) ‪ -‬شريحة خبز فينو‬ ‫الساعة العاشرة صباحا‬ ‫كوب لبن ‪ ،‬أرز مسلوق مضاف إليه قشدة وسكر‬ ‫الساعة الثانية عشر ظه ار‬ ‫ك و وووب حل و ووو الب و وووانم أو ال سو و و را أو ال هلبي و ووة ‪-‬‬ ‫الساعة الثالثة بعد الظهر‬ ‫شريحة خبز مع قطعة زبدة‬ ‫كو وووب يل و و ‪ -‬أرز بو وواللبن ‪ -‬بسو ووكويت ‪ -‬بيضو ووة‬ ‫الساعة السااسة مساء‬ ‫مسلوقة‬ ‫‪Prof. Dr. Naeem Rabeh 2023‬‬  ‫توزيع وجبات مرضى القرحة بعد انقضاء المرحلة‬ ‫الحادة للقرحة على مدار اليوم‪.‬‬ ‫الوجبات الغذائية‬ ‫نوعية األغذية‬ ‫ال مية‬ ‫اإلف ا‬ ‫بو ت طمى‬ ‫ق عة واحدل‬ ‫بيض اسلوق‬ ‫واحدل‬ ‫زبدل‬ ‫العقة صغيمل‬ ‫ق دل‬ ‫العقتان كبيمبان‬ ‫كم‬ ‫العقتان صغيمبان‬ ‫بين الوجبات‬ ‫لبن‬ ‫كوا‬ ‫كم‬ ‫العقتان صغيمبان‬ ‫وخ اعلا‬ ‫نصف كوا‬ ‫الغذا‬ ‫بز‬ ‫غيف صغيم‬ ‫أ ز اسلوق‬ ‫نصف كوا‬ ‫لحو افموة‬ ‫‪ 65‬جماة‬ ‫ب اطس اهمو ة‬ ‫نصف كوا‬ ‫زبدل‬ ‫‪Prof. Dr. Naeem Rabeh 2023‬‬ ‫العقة صغيمل‬  ‫واحد‬ ‫طبق جيلل‬ ‫باكو‬ ‫بسكويت‬ ‫بين الوجبات‬ ‫‪ 65‬جماة‬ ‫لحو دجاج اهمو‬ ‫نصف كوا‬ ‫حسا اا‬ ‫العقة صغيمل‬ ‫زبدل‬ ‫الع ا‬ ‫ثممل واحدل‬ ‫اوز‬ ‫‪ 100‬جماة‬ ‫جبن قميش‬ ‫ق عة واحدل‬ ‫بسكويت‬ ‫عند النوة‬ ‫نصف كوا‬ ‫لبن احلل‬ ‫‪Prof. Dr. Naeem Rabeh 2023‬‬  ‫الو بة‬ ‫الوقت‬ ‫مثال آخر‬ ‫كوا ان اللبن بقمي‬ ‫عند اال تيقاظ‬ ‫‪ 3/4‬كوا عصيم بمبقال‬ ‫‪ 3/4‬عصيدل باللبن والسكم‬ ‫‪ 8‬صباحاً‬ ‫‪ 2‬بياة نصف لق (بمشت)‬ ‫اع بز فينو أو بو ت‬ ‫‪ 10‬صباحاً‬ ‫لحو افموة ‪ ،‬ب اطس اسلوقة‪ ،‬بز أو بو ت‪ ،‬بفاحة أو اوزل‬ ‫‪ 12‬ظه اًم‬ ‫كا تمد أو اهلبية (‪ 3/4‬كوا)‬ ‫‪ 2‬بعد الظهم‬ ‫كوا لبن اع بسكويت‬ ‫‪ 4‬بعد الظهم‬ ‫كوا كا تمد أو لبن ( ايا) أو بز بالزبد‬ ‫‪ 6‬اسا‬ ‫دجاج افموة‬ ‫ب اطس ا وية‬ ‫‪ 8‬اسا‬ ‫بز أو بو ت بالزبد‬ ‫كوا جيلل‬ ‫‪2023‬ان اللبن‬ ‫‪Prof. Dr. Naeem Rabeh‬‬ ‫كوا‬ ‫قبل النوة‬  Recommendations - Avoid spicy foods, alcoholic and carbonated drinks, - stop smoking. - Weight reduction. - Take medications that reduce the amount of acid produced by the stomach after consulting a doctor. - - Drinking milk may help relieve ulcer pain if eaten in moderation Prof. Dr. Naeem Rabeh 2023 Bananas are an excellent food for patients with gastric ulcers, as they contain potassium which is useful for ulcer patients. Taking vitamin C reduces nitrosamines, which are closely linked to stomach cancer, as well as inhibiting the growth of Helicobacter pylori. Prof. Dr. Naeem Rabeh 2023 Zinc (30-50 mg per day) helps speed ulcer healing. Vitamin E (400 international units daily) helps speed ulcer healing. Vitamin A (50,000 IU daily) for two weeks, followed by 10,000-25,000 IU daily for a longer period is considered protective. Avoid eating large amounts of food because the expansion or distension of the stomach may lead to the emergence of painful symptoms Prof. Dr. Naeem Rabeh 2023 Apples, celery, cranberries, ‫ التوت البري‬and green tea, all of which are rich in flavonoids, have been shown to inhibit the growth of Helicobacter pylori. Recent research has also proven that broccoli contains the compound sulforaphane, which kills Helicobacter pylori and even drug-resistant types. Ginger - turmeric – carob- Cabbage - carrots Prof. Dr. Naeem Rabeh 2023  Thank you Prof. Dr. Naeem Rabeh 2023