PEPTIC ULCER DISEASE. Aman Sulehri. Gastric Physiology. Gastroduodenal Mucosal Defense:- The mucosal defense system can be divided as a three-level barrier Preepithelial Epithelial Subepithelial. Definition:-
Gastroduodenal Mucosal Defense:-
The mucosal defense system can be divided as a three-level barrier
“An ulcer is defined as disruption of the mucosal integrity of the stomach and/or duodenum leading to a local defect or excavation due to active inflammation.”
I. Depending on the site:
A. Duodenal Ulcer: Typically occurs in the first inch of 1st part of the duodenum
B. Gastric Ulcer: Occurs in the lesser curvature adjacent to acid secreting parietal cell mass.
C. Combined: Gastric ulcer type II
Zollinger Ellison syndrome
H. pylori and Acid Peptic Disorders:
The organism also elaborate phospholipases that damage surface epithelial cells.
A specific region of the bacterial genome, the pathogenicity island, encodes the virulence factors cytotoxin-associated antigen(Cag A) associated with more severe epithelial damage, greater acute and chronic inflammation, higher likelihood of PU and gastric cancer
Chronic use of NSAIDs suppresses mucosal prostaglandin synthesis by blocking COX-1 and COX-2
Zollinger-Ellison syndrome associated PU:
Excess gastrin secretion by tumor and hence excess gastric acid production
it is said that gastric ulcers present with pain associated or closely followed by eating ,where-as duodenal ulcer pain is relieved by food.
Burning in nature
Patient awakens with pain at night.
May radiate to the back (consider penetration)
Ulcer appears as a crater with/without slough or bleeding .
In GU, routine biopsy is advised to r/o malignancy while in DU biopsy is done in recurrent cases to r/o H.pylori
DU: Deformed duodenal cap. Trifoliate deformity is seen when secondary duodenal diverticulum occurs
GU: appears as niche in lesser curvature due to ulcer crater and as notch on greater curvature due to spasm of stomach
Invasive (Endoscopy/Biopsy Required);
Three kits (ie, CLOtest, Hp-fast, Pyloritek) are commercially available, each containing a combination of a urea substrate and a pH sensitive indicator. One or more gastric biopsy specimens are placed in the rapid urease test kit. If H pylori is present, bacterial urease converts urea to ammonia, which changes pH and produces a color change.
Gastric outlet obs.