DEFINITION-Peptic ulcer is a break the continuity of oesophageal, gastric, or duodenal mucosa.
Types of peptic ulcer-
1. Gastric ulcer
2. Duodenal ulcer
3. Stress ulcer
4. Esophageal ulcer
5. Apthonas ulcer
1. Gastric ulcer- It is ulceration of the mucus lining of stomach. It may extend to sub mucosal layer which tents to heal within few weak within one inch of pylorus of stomach. In an area where gastritis is common. And size of gastric ulcer more than 5 mm.
2. Duodenal ulcer- its higher incidence more than gastric ulcer. This ulcer usually occurs within .6 inch or 1.5 cm of pylorus usually characterized by high gastric hcl secretion.
3. Stress induce ulcer- Sever trauma, burn, aspirin, Nsaid, Steroid, etc. decrease the mucus secretion and break the mucosa stimulate the parasympathetic system.
ETIOLOGY-
1. H. Pylori bacteria infection 90 percent duodenal ulcer and 60 percent gastric ulcer.
2. Defensive resistance of mucosa depend on the following factors-
• Mucosal integrity and regeneration
• Presence of protective mucosal barrier
• Adequate blood flow
• Ability of duodenal inhibitory mechanism to regulate secretion
• Presence of adequate gastro mucosal prostaglandins
• Hyperacidity
• Gastrin secreting begnin & malignant
RISK-FACTORS
– Age 40 to 60 years
– Children & adult
– Stress
– NSAID
– Smoking & alcohol
– Zollinger elision syndrome
– Hepatic & billiary disease
PATHOPHYSIOLOGY-
Due to etiological factor or H. Pylori infection
Increase defensive resistance of the mucosal membrane
Increase HCL secretion
HCL with pepsin damage the mucosal wall
Peptic ulcer
SIGN & SYMPTOMS
1. Pain- Pain is itching, burning,& cramp like pain.
2. In gastric ulcer left upper epigatrium & right epigastrium.
3. Constipation & Diarrhea
4. Acute swelling
5. Nausea & Vomiting
6. Bleeding
COMPLICATION-
• Excessive bleeding
• Perforation
• Obstructions
MANAGEMENT –
1. Antibiotics bismuth salt eradicate H. Pylori
2. Histamine receptor antagonist eg- Rentac, cemetidine
3. Proton pump inhibitor
4. Antacid eg-mgcl
5. Mucosal barrier fortifier e.g.- sucralpate
