git pud 2013
DESCRIPTION
Peptic ulcer disease.TRANSCRIPT
PEPTIC ULCER DISEASE
Dr. M SHEKHANI
AETIOLOGYAETIOLOGY
ContentsContents
DEFINITIONDEFINITION
PATHOPHYSIOLOGYPATHOPHYSIOLOGY
PREDISPOSING FACTORSPREDISPOSING FACTORS
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MANAGEMENTMANAGEMENT
ContentsContents
D.DIAGNOSISD.DIAGNOSIS
DIAGNOSTIC WORK-UPDIAGNOSTIC WORK-UP
MEDICATIONS LISTMEDICATIONS LIST
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• Mucosal defect in the lower oesophagus, stomach or duodenum, in the jejunum after surgical anastomosis to the stomach or, rarely, in the ileum adjacent to a Meckel’s diverticulum..
Definition:Definition:
Epidemiology:Epidemiology:
• M/F for DU 5:1 - 2:1, GU 2:1 or less.
• Chronic gastric ulcer is usually single; 90% on the lesser curve within the antrum or body-antral junctio.
• Chronic DU usually occurs in D1 just distal to the pyloric; 50% on anterior.
• GU/DU coexist in 10%
• > 1 PU is found in 10–15%.
PathophysiologyPathophysiology
H Pylori
NSAIDs
Smoking
9O% DU,70% GU.In DU infect D cells leading to hypergastrinemia&hyperacidity.
30%;Impair mucosal defence through inhibiting PGs.
> Complication & < healing.
HP>90% DU>70% GU
Smoking NSAIDs
H Pylori: in > 50% of gen population
?GeneticsRarely ZES
Pathophysiology: How HP produces PUD.Pathophysiology: How HP produces PUD.
NSAIDs use.
cagA
vacA
Adhesins (BabA)&(o
ipA)
•IL-1β expression
•Smoking
Bacterial factors:
Host genetic polymorphisms:
Clinical features:Clinical features:
Poor predictors of PUDPresence.
Poor predictors of PUDPresence.
40% vomiting
30% atypical
In some
Symptoms
R/Rs
Daily vomiting? GOO
Elderly on NSAIDs: unease;anorexia
Asymptomatic present with complications as GIB, Perforation.
Investigations:Investigations:
Endoscopy
1. For DU not needed because mostly benign except for HP diagnosis or if giant or atypical features( Crohns,TB,Lymphoma,cancer).
2. For GU needed BZ may be malignant.
HP test
Endoscopic biopsy:Endoscopic biopsy:
90%: Pan head or duodenum
50% multiple
½-2/3 malignant but slow growing
20-60% part of MEN1
Diagnosis: Serum gastrin 10-1000 fold increase& paradoxical inc with secretin. Localization by: EUS& SST Rec scintigraphy.
Features:Short historyComplicated more.Ulcers> in unusual sites, D2,Jej,eso.Unresponsive to trt.Recurs after surgery.Diarrhea in 50%.
Diagnosis:
ZES:GastrinomaZES:Gastrinoma
Drugs for PUD:Drugs for PUD:
Acid suppresants:
PPI/HSRAs/Antacids
Mucosal resistance enhancers
Both:
Sucralfate/Carbinoxolone.
Prpstaglandins.