Peptic Ulcer.pdf

Peptic Ulcer Normal gastric and duodenal mucosa is protected from digestive actions of pepsin and acid by: Secretion of mucus Production of bicarb Removal of excess acid by normal blood flow Rapid renewal and repair of epithelial cell injury Effects Stomach and Duodenum’s mucosa Associated with chro...

Peptic Ulcer Normal gastric and duodenal mucosa is protected from digestive actions of pepsin and acid by: Secretion of mucus Production of bicarb Removal of excess acid by normal blood flow Rapid renewal and repair of epithelial cell injury Effects Stomach and Duodenum’s mucosa Associated with chronic gastritis (ex. H. pylori, NSAIDs) Acid causes inflammation (tx goal: â gastric secretion acidity) Can lead to cancer Symptoms and Complications Common Symptoms: o Gnawing or burning pain o Bloating o Nausea and vomiting o Unintentional weight loss o Loss of appetite Complications: o Progressive dysphagia o Iron deficiency anemia o Perforation (of stomach, duodenum, adj organs) o Hemorrhage o Melena (black stools from GI bleed) Diagnosis of Peptic Ulcers Histology: o Granulation tissue in muscularis propria, submucosa o Inflammatory debris at surface of epithelial mucosa o Fibrinoid tissues around lamina propria, down in gland spaces o Lymphocytes, plasma cells present Testing for PUD: o Endoscopy w biopsy § Forrest Classification: Defines grade of ulceration § Stage 1 is worst (Re-bleeding in 50-100% of cases) o H. pylori test § Stool, breath Forrest Classification 3 stages Description Stage Characteristic Ia Spurting Blood Ruptured artery, rapid Life threatening Ib Oozing blood Capillary bleeding IIa Non-bleeding Visible vessel is an endoscopic sign to us know if pt is bleeding IIb Adherent clot Most freq sign of bleeding in gastric and duodenum Accumulation of clotting visible vessel IIc Flat spot in ulcer crater Black spot indicates necrotic tissue III Clean base ulcer Debris, necrotic tissue seen but no bleeding/clot Least dangerous, can advance to Type I, II Re-Bleeding 50-100% 7-50% 3-5% Medical Management of Peptic Ulcers Medical Management o PPI o H2 receptor blockers o Antibiotics in case of H pylori infection Surgical Management o Endoscopic, open, laproscopic procedure (individual lesions) o Partial/total gastrectomy § Cutting part of stomach or removing stomach § Connects esophagus to small intestine o Selective Vagotomy § Cut vagus nerve § Reduces acid secretion in stomach Nutrition Management of Peptic Ulcers Misconceptions o Milk § Protein foods buffer gastric secretion § Can also stim gastrin, acid, pepsin secretion o pH of Food § Little therapeutic importance except for pts w existing lesions of mouth, esophagus Avoid o Alcohol § Heavy consumption causes superficial mucosal dmg § Beer/wine increases gastric secretion o Coffee § Caffeinated/Decaf stimulates acid secretion § Irritates stomach o Spices § Inc gastric acid secretion § Cause small erosions, inflammation of mucosal lining — Chili, peppers, cayenne o Large meals § Avoid before sleeping (2-3 hrs) § Reduce latent increase in acid secretion Dietary o Consume high quality (nutrient dense) diet w: § Adequate fiber § Probiotics § Omega 3 o Frequent small meals: § Increase comfort § Decrease chance of acid reflux § Stimulate gastric blood flow § Increase net acid output:; body gets rid of acid through kidney