Peptic ulcer
Contents
• Peptic
ulcer
• Pathophysiology
of peptic ulcer
• Symptoms
of peptic ulcer
• Anti-ulcer drugs
Objectives
At the end of this
lecture, student will be able to
• Explain
the pathophysiology of peptic ulcer
• Describe
the symptoms
• Classify Antiulcer drug
Peptic ulcer
•
Peptic
ulcer very common disease of alimentary tract
•
Peptic
Ulcer(PU) is an ulcer of the GIT at an area exposed to the acid pepsin mixture
(APM),i.e.the mucosa of the GIT
•
This
area is digested by pepsin (peptic digestion), hence the name
•
A peptic
ulcer is an ulcer (defined as mucosal erosions)
of an area of the gastrointestinal tract that is usually exposed to the aggressive action of
acid-peptic juices
•
It
causes inflammatory injuries in either the gastric or duodenal mucosa, with
extension beyond the submucosa into the muscularis mucosa
•
A peptic
ulcer of the stomach is called a gastric ulcer & ulcer of duodenum is
called a duodenal ulcer and of the esophagus is called an esophageal ulcer
Sign & Symptoms
• Dyspepsia (Indigestion)
• Abdominal
pain
• Heart
burn
• Bloating
(swollen state)
• Nausea
• Anorexia
• Weight
loss
• Melena (Black vomit)
Pathophysiology
of PUD
Gastro duodenal mucosal integrity is determined by
protective (“defensive”) and Damaging (“aggressive”) factors
• Gastric and duodenal ulcers usually
cannot be differentiated based on history alone, although some findings may be
suggestive.
• Epigastric pain is the most common
symptom of both gastric and duodenal ulcers.
• It is characterized by a gnawing or
burning sensation and occurs after meals—classically, shortly after meals with
gastric ulcer and 2-3 hours afterward with duodenal ulcer.
• Under normal conditions, a
physiologic balance exists between gastric acid secretion and gastroduodenal
mucosal defense.
• Mucosal injury and, thus, peptic
ulcer occur when the balance between the aggressive factors and the defensive
mechanisms is disrupted.
• Under normal conditions, a
physiologic balance exists between gastric acid secretion and gastroduodenal
mucosal defense.
• Mucosal injury and, thus, peptic
ulcer occur when the balance between the aggressive factors and the defensive
mechanisms is disrupted.
Secretion
of HCl by gastric parietal cell and its regulation
Diagnostic tests
• Barium swallow: You drink a thick white liquid
(barium) that coats your upper gastrointestinal tract and helps your doctor see
your stomach and small intestine on X-rays
• Endoscopy (EGD): A thin, lighted tube is
inserted through your mouth and into the stomach and the first part of the
small intestine
• This test is used to look for
ulcers, bleeding and any tissue that looks abnormal
• Endoscopic biopsy: A piece of stomach tissue is
removed so it can be analyzed in a lab.
Classification of antiulcer drugs
1. Reduction
of gastric acid secretion
(a) H2 antihistamines:
Cimetidine, Ranitidine,Famotidine,
Roxatidine
(b) Proton
pump inhibitors: Omeprazole, Lansoprazole, Pantoprazole,
Rabeprazole,Esomeprazole
(c)
Anticholinergics: Pirenzepine, Propantheline,Oxyphenonium
(d)
Prostaglandin analogue: Misoprostol
2. Neutralization of gastric acid (Antacids)
(a) Systemic:
Sodium bicarbonate, Sodium citrate
(b)
Nonsystemic: Magnesium hydroxide, Magnesim trisilicate, Aluminium hydroxide
gel, Magaldrate, Calcium carbonate
3. Ulcer protectives: Sucralfate, Colloidal bismuth
subcitrate (CBS)
4. Anti-H. pylori drugs: Amoxicillin,
Clarithromycin,Metronidazole, Tinidazole, Tetracycline
Summary
• Peptic
Ulcer(PU) is an ulcer of the GIT at an area exposed to the acid pepsin mixture
(APM),i.e.the mucosa of the GIT
• The pathophysiological structure
shows aggressors like increased acid and pepsin, an impaired defence system of
the mucosa.
• Acute ulcers and erosions present clinically with gastrointestinal bleeding or perforation
Posts
0 Comments