3. Break in the gastrointestinal mucosa
exposed to the aggressive action of acid-
peptic juices.
Common sites are the
first part of the
duodenum and the
lesser curve of the
stomach.
4. The gastroduodenal mucosal integrity is
determined by protective (defensive) &
damaging (aggressive) factors.
6. H. Pylori Infection
NSAIDs
Smoking & Alcohol
Acid Hypersecretion
Stress
Family History of PUD.
7.
8. Duodenal Ulcer Gastric ulcer
Age Any age specially 30-40 middle age 50-60
Sex More in male More in male
Occupation Stress job eg. Manager Same
Pain Epigastric , discomfort Epi. Can radiate to
back
Onset 2-3 hours after eating & Immediately after
midnight eating
Agg.by Hunger Eating
9. Duodenal Ulcer Gastric ulcer
Relived by Eating Lying down or vomiting
Duration 1-2 months Few weeks
Vomiting Uncommon Common(to relieve the
pain)
Appetite Good Pt. afraid to eat
Diet Good , eat to relieve the pain Avoid fried food
Weight No wt. loss wt. Loss
Hematemesis 40% 60%
Melena 60% 40%
10. Stool fecal occult blood.
CBC CBL.
Rapid Urease test, urea
breath test H. Pylori.
Upper GI Endoscopy.
Barium meal X-Ray.
11. Any patient >50 y/o with new
onset of symptoms
In all patients with “Alarming
symptoms” endoscopy is required.
Dysphagia.
Weight loss.
Vomiting.
Anorexia.
Hematemesis or Melena.
16. H. pylori Eradication Therapy:
• Triple therapy:
Proton pump inhibitor .
2 Antibiotics:
• Metronidazole + Clarithromycin.
• Clarithromycin + Amoxicillin.
» In some regimens, H2-receptor
blockers, e.g. ranitidine, are used
instead of PPI.
17. Indications:
Failure of medical treatment.
Development of complications
High level of gastric secretion and
combined duednal and gastric ulcer.
Principle:
Reduce acid and pepsin
secretion.
18. Vagotomy:
Truncal Vagotomy with drainage.
Highly selective Vagotomy.
Combination of vagal
denervation (vagotomy) +
anterctomy.
19. Truncal vagotomy with drainage:
Resect the major trunk of the vagus to
the stomach this will lead to:
Decrease acid and pepsin secretion.
Impair antral motility and drainage.
– Two types of drainage:
Pyloroplasty.
Gastrojejnostomy.
20.
21.
22. Highly selective vagotomy:
• It is a parietal cells vagotomy.
• It can be done with or without
drainage.
• It is done by cut a branch
of vagus of the body and
the fundus this will lead to
decrease HCl production.