pathology of peptic ulcer
TRANSCRIPT
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PEPTIC ULCERMujahid Nadeem (13612)Ali Raza (13621)Arslan Tahir (13635)Ansar Ali Raza (13665)
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CONTENTS INTRODUCTION
TYPES
ETIOLOGY
PATHOGENESIS
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INTRODUCTION
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INTRODUCTION
Ulcer An ulcer is a discontinuity or break in
a bodily membrane that impedes the organ of which that membrane is a part from continuing its normal functions.
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Types of Ulcers
Peptic ulcer i. Esophageal ulcerii. Duodenal ulceriii. Gastric ulcer Pressure ulcerGenital ulcerUlcerative dermatitis Anal fissureDiabetic foot ulcer
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Types of Ulcers (Cont.)
Corneal ulcerMouth ulcerVenous ulcer Stress ulcerUlcerative sarcoidosis Ulcerative lichen planusUlcerative colitisUlcerative disposition
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Peptic Ulcer
Also known as “peptic ulcer disease” (PUD)
Peptic ulcer is a break in the lining of the stomach, first part of the small intestine, or occasionally the lower esophagus.
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Sites of peptic ulcer
Duodenum …………….…… 80%
Stomach …………………….. 19%
Duodenum & Stomach ….. 4%
GE junction ………………….. Meckel’s diverticulum ……. 1%
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Occurrence of peptic ulcer
Serious medical problem Approx. 500,000 new cases each
year 5M people affected in USA only Mostly occur between 55 ot 65 years
of age Duodenal ulcer more common in
men than women Gastric ulcer more common in
women than men
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Occurrence of peptic ulcer (Cont.)
Duodenal ulcers are four times more common than gastric ulcers
Mortality rates from peptic ulcer are low
High prevalence One of several upper GIT diseases
that is caused ,partially, by gastric acid
Wide range of symptoms
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Symptoms
Abdominal pain• Located in epigastric area • Burning in quality• Occur on an empty stomach 2-4
hours after meal or at night (nocturnal pain)
• Relieved by antacids• Tend to wax and wane over months
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Symptoms (Cont.)
PerforationsBlotting and abdominal fullnessNausea and vomitingLoss of appetite (because of pain)Weight lossStomach obstructionHeartburnHematemesisMelenaDeep tenderness
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TYPES OF PEPTIC ULCER
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Acute Peptic Ulcera. Cushing ulcerb. Curling ulcer
Chronic Peptic Ulcera. Duodenal ulcerb. Gastric ulcerc. Esophageal ulcerd. Bleeding ulcere. Refractory ulcer
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Acute (Stress) Peptic Ulcer
Cushing Ulcer Gastric, duodenal or esophageal ulcer arising in patients with intercranial injury or operation
Curling Ulcer Occuring mosty in the proximal duodenum and associated with severe burns and trauma
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Chronic Peptic Ulcer
Gastric Ulcer A gastric ulcer is a sore that is on the inside of the stomach Causes Infection with Helicobecter pylori NSAIDs (e.g. aspirin, ibuprofen,
diclofenac)
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Chronic Peptic Ulcer (Cont.)
Duodenal Ulcer The peptic ulcer having a sore on the upper part of small intestine Causes H.pylori Damaging of lining of mucosal wall
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Chronic Peptic Ulcer (Cont.)
Esophageal Ulcer Open sores or lesions in the lining of
esophagus Mostly occur in the lower end of
esophagusCauses Associated with bad case of chronic
gastro esophageal reflux disease or GERD
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Chronic Peptic Ulcer (Cont.)
Bleeding Ulcer Internal bleeding is caused by a
peptic ulcer which has been left untreated
When this happens it is now referred to as bleeding ulcer
Most dangerous type of ulcer
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Chronic Peptic Ulcer (Cont.)
Refractory Ulcer These are simply peptic ulcers that have not healed after at least 3 months of treatment
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ETIOLOGY OF PEPTIC
ULCER
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What Causes Ulcers?
No single cause
End result of an imbalance between digestive fluids in stomach and duodenum
Most common cause of ulcer is infection with a type of bacteria called Helicobacter pylori (H.pylori)
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Factors that can increase the risk of ulcers
Use of NSAIDs (such as aspirin, naproxen, ibuprofen and many others prescription medicines; even safety-coated aspirin and aspirin in powder form can cause ulcers
Excess acid production from gastrinomas (tumors of acid-producing cells)
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Factors that can increase the risk of ulcers
(Cont.) Excessive drinking
Smoking or chewing tobacco
Serious illness
Radiation treatment of the area
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Who is more likely to get ulcers?
Those people are more like to get ulcers who:
Are infected with H.pylori Take NSAIDs (aspirin, ibuprofen or naproxen
etc.) Have a family history of ulcers Have another illness such as liver, kidney or
lung disease Drink regularly
Are age 50 or older
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How are ulcers treated?
If not properly treated, they can lead to serious health problems
Ulcers can be treated by following ways:
Lifestyle changes
Medication
Surgery
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Lifestyle changes
Eliminate substrate that can causing ulcers
Stop drinking and/or smoking
Stop using NSAIDs
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Ulcer Medication
Proton Pump Inhibitors(PPIs) Reduce acid level and allow ulcer to heal These include: • Dexlansoprazole, • Esomeprazole• Lansoprazole• Omeprazole• Pantoprazole• Rabeprazole• Omeprazole/sodium bicarbonate etc.
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Ulcer Medication (Cont.)
Antibiotics
Used for H.pylori induced ulcers
Multiple combinations of antibiotics are used
Taken for 2-3 weeks along with PPIs
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Ulcer Medication
Upper Endoscopy
Bleeding ulcers can be treated using an endoscope
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Surgery
Surgery is needed if:
Ulcer creates a hole in the wall of stomach
There is serious bleeding that cannot be controlled with an endoscope
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How to reduce the risk of developing ulcers?
Don’t smoke
Don’t drink
Don’t overuse aspirin or NSAIDs
If you have symptoms of ulcer, contact your health care provider
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PATHOGENESIS OF PEPTIC
ULCER
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H.pylori INDUCED ULCERGram negative bacteria produced heat shock proteins
Cytokines, histamine, lipopolysaccharides, certain enzymes
Phospholipase
Urease, protease, fucosidase etc. Urease convert in acidic media urea into ammonia
and carbon dioxide. Ammonia itself cause destruction of mucosal lining.
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Ammonia cause infection of mucosal lining and ultimately inflammatory mediators release.
Cytokines Leukocytes adhesion and inflammatory reactions starts
Damage mucosa of GIT
Ulcer occurs
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DRUG INDUCED ULCER
Drugs for example NSAIDS as aspirin(non selectively inhibit cox1 and cox2 in human bodyArachidonic acid cox1,2 Prostaglandins
Controls gastric juice secretions
Damage mucosal lining lead to ulcer
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STRESS INDUCED ULCERIn stress energy consumption increase so increase
glycolysis which is usually done by cortisol hormone
This hormone inhibit phospholipase A2
No arachidonic acid formation no prostaglandin increase gastric juice secretions
Cause ulcer
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STEROIDS INDUCED ULCER Steroids acts on cell membrane
(phospholipid)
Inhibit phospholipase
Inhibits arachidonic acid no prostaglandins and damaging of mucosal lining
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ULCER DUE TO GENETIC DEFECTRare genetics occurs some time having
blood group O positive the size of parietal cell is increase
Increase cell demand as HCL secretions increase
Cause destruction of mucosal lining leading towards ulcer
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ZES(Zollinger-Ellison Syndrome)
In this syndrome tumor of goblet cell occurs
Abnormal mucus secretions(gastrin acts on parietal cells)
Increase secretions of gastric juice
Mucosal lining damage
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