Peptic Ulcer Disease. Peptic Ulcer Disease



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Peptic Ulcer Disease.

  • Peptic Ulcer Disease.

  • Inflammatory Bowel Disease.

  • Acute diarrhea.



Peptic ulcerations are excavated defects (holes) in the gastrointestinal mucosa that result when epithelial cells succumb to the caustic effects of acid and pepsin in the lumen.

  • Peptic ulcerations are excavated defects (holes) in the gastrointestinal mucosa that result when epithelial cells succumb to the caustic effects of acid and pepsin in the lumen.

  • Peptic ulcer disease commonly used term to refer to ulcerations of the stomach, duodenum, or both, that is caused by acid-peptic injury.



Histological, ulcers are necrotic mucosal defects that extend through the muscularis mucosa and into the submucosa or deeper layers.

  • Histological, ulcers are necrotic mucosal defects that extend through the muscularis mucosa and into the submucosa or deeper layers.

  • More superficial necrotic defects are named erosions.



In the early part of the 20th century, stress and diet were considered to be the pathogenetic factors for PUD, so treatment was with bed rest and diet.

  • In the early part of the 20th century, stress and diet were considered to be the pathogenetic factors for PUD, so treatment was with bed rest and diet.

  • 1950, clinicians had focused their attention on the pathogenetic role of gastric acid, so antacid therapy had become the treatment of choice.

  • 1970, histamine H2 receptor antagonists became available, and acid suppression with antisecretory therapy was the treatment of choice for UD.

  • 1980, proton pump inhibitors (PPI) were discovered, with more potent acid suppression and higher rates of ulcer healing.

  • Using alone antisecretory drugs, will have recurrence within one year in most patients



H. pylori was discovered in April 1982 by two Australian physicians, Dr. Barry Marshall and Dr. Robbin Warren.

  • H. pylori was discovered in April 1982 by two Australian physicians, Dr. Barry Marshall and Dr. Robbin Warren.

  • In 1983 the two doctors proposed that the bacterium is the cause of peptic (duodenal and gastric) ulcers.

  • Dr. Marshall even went so far as to inoculate himself with the bacterium to prove his point.

  • it soon became apparent just how widespread and serious the H. pylori threat is.

  • Researches confirm that over 90 per cent of people with peptic ulcers are infected with the bacterium.

  • In 1987 the Sydney gastroenterologist Thomas Borody invented the first triple therapy for the treatment of duodenal ulcers.





United Kingdome United states

  • United Kingdome United states

  • Duodenal ulcer Peptic ulcer disease

  • Gastric ulcer( Benign) Gastroesophageal

  • varices

  • Esophagitis Angiomas

  • Mallory-Weiss tear Mallory-Weiss tear

  • Gastroesophageal varices Tumors

  • Gastritis or gastric erosions Erosions

  • Tumors Dieulafoy's lesion



Duodenal ulcer 41.90%

  • Duodenal ulcer 41.90%

  • Esophageal varices 16.07%

  • Erosive gastritis/duodenitis 14.09%

  • Esophagitis 8.64%

  • Gastric ulcer 5.87%

  • Gastric and duodenal ulcers 3.60%

  • Esophageal ulcer 3.25%

  • Anastomotic ulcer 2.26%

  • Mallory-Weiss tear 1.55%

  • Esophageal tumor 1.41%

  • Gastric tumor 1.27%

  • Waseem H. et al. Upper G.I Bleeding in Jordan- Retrospective statistical analysis 1996-2000



Peptic Ulcer Disease.

  • Peptic Ulcer Disease.

  • Inflammatory Bowel Disease.

  • Acute diarrhea.



  • Ulcerative colitis

  • Crohn’s disease







Fibrosis

  • Fibrosis

  • Shortening of the colon

  • Bleeding

  • Stricture

  • Bowel perforation

  • Toxic megacolon



Arthritis

  • Arthritis

  • Iritis

  • Erythema nodosum

  • Pyoderma gangrenosum

  • Sclerosing cholangitis

  • Aphthous stomatitis

  • Thromboembolic disorders



Bloody diarrhoea

  • Bloody diarrhoea

  • Fever

  • Cramping abdominal pain

  • Weight loss

  • Frequency and urgency of defecation

  • Tenesmus

  • General malaise







Diarrhoea

  • Diarrhoea

  • Abdominal pain

  • Bleeding

  • Pyrexia

  • Weight loss

  • Fistulae

  • Perianal disease

  • General malaise



Fistulae

  • Fistulae

  • Abscesses

  • Adhesions

  • Strictures

  • Obstruction





Arthritis

  • Arthritis

  • Gallstones

  • Malabsorption

    • Lactase deficiency
    • Vitamin B12 deficiency
  • Renal stone formation









Genetic

  • Genetic

  • Smoking

  • Dietary

  • Infection

  • Immunological

  • Psychological?



5-ASA-containing compounds

  • 5-ASA-containing compounds

    • mesalazine
      • Pentasa®
      • Asacol®
      • Claversal®/Mesasal®/Salofalk®
    • sulphasalazine
      • Salazopyrin®
    • olsalazine
      • Dipentum®
  • Corticosteroids

  • Immunosuppressants



Perforation

  • Perforation

  • Toxic dilatation

  • Massive haemorrhage

  • Chronic ill-health

  • Risk of cancer



Peptic Ulcer Disease.

  • Peptic Ulcer Disease.

  • Inflammatory Bowel Disease.

  • Acute diarrhea.



Normally 10 liters enter the duodenum daily, of which 1 liter is absorbed by the small intestine.

  • Normally 10 liters enter the duodenum daily, of which 1 liter is absorbed by the small intestine.

  • Colon resorbs most of the remaining fluid with only 100 ml fluids lose in the stool.

  • Medical definition of diarrhea: a stool weight more than 250 g/day.

  • Practical definition: increased stool frequency more than 3 times/day or liquidity.

  • There are 2 types of diarrhea: acute diarrhea (less than 3 weeks) and chronic diarrhea (more than 3 weeks).





Acute diarrhea: acute onset of diarrhea and present for less than 3 weeks

  • Acute diarrhea: acute onset of diarrhea and present for less than 3 weeks

  • Mostly caused by infectious agents, bacterial toxins (ingested preformed in food or produced in gut) and drugs.

  • Similar recent illness in family members suggests an infectious etiology.



Fever absent.

  • Fever absent.

  • Stool without blood or fecal leucocytes.

  • Watery stool with peri-umbilical cramps, bloating, nausea and vomiting (small bowel enteritis) caused by either a toxin or other a toxin producing toxin or other agents that disrupt the normal absorption and secretory process in the small intestine.



  • By examining the absence of the leucocytes in the stool



Viral: Norwalk virus, Rotavirus.

  • Viral: Norwalk virus, Rotavirus.

  • Protozoa: Giardia lamblia, Cryptosporidium.

  • Bacterial:

  • Preformed entero-toxins: Staphylococcus aureus, Bacillus cereus, and Clostridium perfringens.

  • Intra-intestinal enterotoxin production: E. coli (enteropathogen) and Vibrio cholera.

  • New medication.

  • Fecal impaction.



Presence of fever and bloody diarrhea (dysentery) indicates colonic damage caused by invasion (shigellosis, salmonellosis, yersinia and amibiasis) or a toxin (C.difficile, E. coli 0157:H7).

  • Presence of fever and bloody diarrhea (dysentery) indicates colonic damage caused by invasion (shigellosis, salmonellosis, yersinia and amibiasis) or a toxin (C.difficile, E. coli 0157:H7).

  • Colonic diarrhea is a small amount diarrhea in volume (< 1l/day) and associated with left lower quadrant cramps, urgency and tenesmus.

  • Fecal leucocytes are present in infections with invasive organisms.



  • By examining the presence of the leucocytes in the stool



Viral: Cytomegalovirus.

  • Viral: Cytomegalovirus.

  • Bacterial:

  • 1. Cytotoxin production: E. coli 0157:H7 (enterohemorhagic), Vibrio parahemolyticcus and Clostridium difficile.

  • 2. Mucosal invasion: Shigella, Salmonella, enteroinvasive E. coli, aeromonas and Yersinia.

  • 3.Bacterial proctitis: Chlamydia, N. gonorrhea.

  • Protozoa: E. histolytica.

  • Other: Ischemic colitis, I.B.D. and radiation colitis.








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