Git pud 2013.
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This document discusses peptic ulcer disease. It defines peptic ulcer disease and lists its main causes as Helicobacter pylori infection, NSAID use, and smoking. It describes the pathophysiology of how H. pylori infection leads to ulcers by interfering with mucosal defenses and increasing acid production. The document provides details on epidemiology, clinical features, investigations including endoscopy, and medications used to treat peptic ulcer disease such as PPIs, H2 receptor antagonists, and prostaglandins.
Git pud 2013.
- 1. PEPTIC ULCER DISEASE Dr. M SHEKHANI
- 4. Definition: • Mucosal defect in the lower oesophagus, stomach or duodenum, in the jejunum after surgical anastomosis to the stomach or, rarely, in the ileum adjacent to a Meckel’s diverticulum..
- 5. Epidemiology: • M/F for DU 5:1 - 2:1, GU 2:1 or less. • Chronic gastric ulcer is usually single; 90% on the lesser curve within the antrum or body-antral junctio. • Chronic DU usually occurs in D1 just distal to the pyloric; 50% on anterior. • GU/DU coexist in 10% • > 1 PU is found in 10–15%.
- 6. Pathophysiology H Pylori: in > 50% of gen population HP >90% DU >70% GU H Pylori NSAIDs Smoking 9O% DU,70% GU. In DU infect D cells leading to hypergastrinemia&hyperacidity. 30%;Impair mucosal defence through inhibiting PGs. Smoking > Complication & < healing. ?Genetics Rarely ZES NSAIDs
- 7. Pathophysiology: How HP produces PUD. Adhesins (BabA)&(o ipA) Bacterial factors: vacA cagA •Smoking Host genetic polymorphisms: •IL-1β expression NSAIDs use.
- 11. Clinical features: 40% vomiting In some Asymptomatic present with complications as GIB, Perforation. Daily vomiting? GOO R/Rs 30% atypical Elderly on NSAIDs: unease;anorexia Symptoms Poor predictors of PUD Presence.
- 12. Investigations: Endoscopic biopsy: 1. For DU not needed because mostly benign except for HP diagnosis or if giant or atypical features( Crohns,TB,Ly mphoma,cancer). 2. For GU needed BZ may be malignant. nd E py co os HP test
- 20. ZES:Gastrinoma 90%: Pan head or duodenum 50% multiple ½-2/3 malignant but slow growing 20-60% part of MEN1 Features: Short history Complicated more. Ulcers> in unusual sites, D2,Jej,eso. Unresponsive to trt. Recurs after surgery. Diarrhea in 50%. Diagnosis: Diagnosis: Serum gastrin 10-1000 fold increase& paradoxical inc with secretin. Localization by: EUS& SST Rec scintigraphy.