"Each time you are honest and "Each time you are honest and conduct yourself with honesty, a conduct yourself with honesty, a success force will drive you toward success force will drive you toward greater success. Each time you lie, greater success. Each time you lie, even with a little white lie, there are even with a little white lie, there are strong forces pushing you toward strong forces pushing you toward failure."failure."

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Pathology of Peptic Ulcer

By ali azizBy ali aziz

Normal Stomach

Esophagus & Stomach Normal

Definition:

Ulceration (breach in mucosa) due to acid & pepsin attack – peptic ulcer.

Deeper than just mucosa

Single, punched out, clean base – why?

Etiology: (study of causes)

Helicobacter pylori infection.(bacteria)

Hyperacidity –

Drugs - anti-inflammatory (NSAIDs) & Corticostroids.

Cigarette smoking, Alcohol,

Rapid gastric emptying

Personality and stress

H. Pylori organisms- silver st.

Pathogenesis: : (process)

Helicobacter pylori infection

Colonization of gastric mucous

Urease ammonia neutralization of acid Rebound acid production.

Protease – Mucous break down.

Weak mucosal resistance

Acid & Pepsin digestion of mucosa

Chronic Ulceration

Etiology of PUD

Normal

Increased Attack Hyperacidity

Weak defense Helicobacter pylori* Stress, drugs, smoking

Helicobacter pylori:

Most common infection in the world (20%)

10% of men, 4% women develop PUD *

Positive in 70-100% of PUD patients.

H.pylori related disorders:Chronic gastritis – 90%Peptic ulcer disease – 95-100%Gastric carcinoma – 70%Gastric lymphomaReflux Oesophagitis.Non ulcer dyspepsia

Peptic Ulcer Morphology:

90% ulcers in first portion of duodenum or lesser curvature of stomach(4:1).

80 to 90% cases single ulcer. Round Small ulcers with sharply punched out edges*

Small <2cm, clean base*.

Microscopy: 4 zones. Superficial necrotic layer. Inflammatory cells zone. Granulation tissue zone Collagenous scar layer.

Complications:

Bleeding – Chronic-IDA, Acute, Massive

Fibrosis, Stricture obstruction – pyloric stenosis.

Perforation – Peritonitis- emergency.

Gastric carcinoma. (not duodenal ca)

Acute Esophagitis & Gastritis

Gastric peptic ulcer:

Gastric peptic ulcer:

Gastric Ulcer

Duodenal Peptic Ulcer

Gastric Ulcer

Peptic ulcer - Endoscopy

Gastric Ulcer

Gastric Ulcer

Gastric UlcerPunched out ulcer

Clean base

Small single

Radiating mucosal folds.

Benign ulcer.

No tumor.

Peptic Ulcer

Peptic Ulcer Microscopy:

Perforation:

Acute Esophagitis & Gastritis

Fungating

Linitis Plastica – Schirrhous Carcinoma.

Helecobacter pylori

Gram negative, Spiral bacilli

Spirochetes

Do not invade cells – only mucous

Breakdown urea - ammonia

Break down mucosal defense

Chronic Superficial inflammation

PUD - Diagnosis

Endoscopy

Barium meal – contrast x-ray

Biopsy – bacteria & malignancy

H.Pylori:Endoscopy cytologyBiopsy – Special stainsCulture - difficultUrease Breath test.

Points to Remember:

A peptic ulcer is a sore in the lining of the stomach or duodenum due to attack by acid & Pepsin.

The major cause - H. pylori bacterium. Others are NSAIDs. spicy food, stress are risk factors.

H. pylori can be transmitted from person to person through close contact

A combination of antibiotics and H pump inhibitors is the most effective treatment.

Helecobacter pylori

“You get ulcer, not from what you eat, but from what’s

eating you..!”