3.  In India, the prevalence of peptic ulcers is
estimated to be 4-10 per1000 population

4.  Age 30–60
 Male: female–3:1

5.  H. pylori,
 Alcohol,
 Smoking,
 Cirrhosis,
 Stress
 Usually 50 and over
 Male higher risk
 Normal hypo secretion of stomach acid (HCl)
(zollinger Ellison syndrome)
 Gastritis,
 Use of NSAIDs

6.  Acute
 Chronic

7.  Is associated with superficial erosion and
minimal inflammation it is of short duration
and resolves quickly when the cause is
identified and removed

8.  Chronic ulcer is one of long duration eroding
through the muscular wall with the formation
of fibrous tissue it may be present
continuously for many months or
intermittently throughout the person’s life
time

9.  Gastric
 duodenal

10.  stress and anxiety
 gram-negative bacteria H. pylori
 Stress
 Excessesive secretion of HCL
 Familial tendency
 Blood group o
 Use of NSAID
 Alcohol
 Excessive smoking
 Hyperacidity
 Gastrin secreting malignant tumers
 Esophagial ulcers
 GERD

11.  In addition to the inflammation caused by
H.pylori infection, there are certain other factors
that contribute to peptic ulcer. Peptic ulcer
occurs mainly in the gastro duodenal mucosa
because this tissue cannot withstand the
digestive action of gastric acid HCl and pepsin.
Vagus nerve stimulates the parietal cells to
secrete gastric acid. The erosion is caused by the
increased concentration or activity of pepsin, or
by decreased resistance of the mucosa. A
damaged mucosa cannot secrete enough mucus
to act as a barrier against HCl. The use of NSAIDs
inhibits the secretion of mucus that protects the
mucosa.

14.  dull, gnawing pain or a burning
 Pain is usually relieved by eating
 Tenderness
 pyrosis (heartburn),
 vomiting, constipation or diarrhea, and
bleeding
 burping
 vomiting
 bleeding
 tarry stools

15.  pain,
 epigastric tenderness,
 or abdominal distention.
 A barium study
 Stools study
 . Gastric secretory studies
 H. pylori infection
 breath test that detects H. pylori

16.  Antibiotics
 Eradicate H. pylori
 Rest
 sedatives
 Tranquilizers
 Octreotide
 cytoprotective agents

17.  proton pump inhibitors
 antibiotics
 bismuth salts
 histamine 2 antagonist
 proton pump inhibitors

18.  stressful or exhausting.
 A rushed lifestyle
 irregular schedule

19.  smoking decreases the secretion of
bicarbonate from the pancreas into the
duodenum resulting in increased acidity of
the duodenum.

20.  avoiding extremes of temperature
 overstimulation from consumption of meat
extracts
 alcohol,
 coffee (including decaffeinated coffee,
 Milk
 cream

21.  Principles of surgery
 Reduce acid secreting ability
 Remove malignant or potentially malignant
lesions treat surgical emergency
 Treat clients do not respond to medical
intervention

22.  Vagotomy is performed to eliminate the acid
secreting stimulus to gastric cells
 Truncal
 Completely cutting each vagus nerve
 Selective
 The surgeon partially severs the nerves to
preserve the hepatic and celiac branches
 Proximal
 Only paritel cell mass is denerveted

25.  Permits regurgitation of alkaline deodenal
contents thereby neutralizing gastric acid in
this procedure a drain is made on the bottom
of the stomach and sewn to an opening made
in the jejunum

27.  This is a genetic term referring to any surgery
that involves partial removal of the stomach
may be performed by either Billroth 1 or
Billroth 2

28.  Operation was devised more by accident thanà
surgery design A gastro enterostomy was
performed on a gravely ill patient with a pyloric
resection by Christian Aiberl Theociot Billroth.
1829-1894, Professor of
Surgery, Vienna, Austria. Anton wolfler. 1850-
1917, Professor of Surgery, Prague, The Czech
Republic further refined the surgery The first
successful gastrectomy was performed by Billroth
in January 1881, and Wolfler performed the first
gastroenterostomy in the same year

29.  The surgeon removes a part of distal portion
of the stomach including the andrum the
remainder of the stomach is anastomosed to
duodenum this combined procedure called
gastrodeodenostomy this decreases dumping
syndrome

31.  This involves reanastomosis of the proximal
remnant of the stomach to the proximal
jejunum pancreatic secretions and bile
continue to secrete in jejunum even after
surgery surgeons prefer Billroth 2 technique
for treatment of duodenal ulcers because
recurrent ulcer develops less frequent in this
procedure

33.  Dumping syndrome
 Early dumping
 Early dumping include abdominal and
vasomotor symptoms which are found in 5-
10%of patients the small bowel is filled with
food from stomach which have high osmotic
load this lead to shift of fluid to stomach
from systemic circulation symptoms are
vertigo, tachycardia syncope sweating pallor
palpitation diarrhea and nausea etc

34.  This is reactive hypoglycemia. The
carbohydrate load in the small bowel causes a
rise in the plasma glucose level, which, in
turn, causes insulin levels to rise, causing a
secondary hypoglycemia. This can be easily
demonstrated by serial measurements of
blood glucose in a patient following a test
meal. Other symptoms include epigastric
fullness distention discomfort abdominal
cramping nausea etc the treatment is
essentially the same as for early dumping

35.  The principal treatment is dietary
manipulation, dry meals are best, and
avoiding fluids with a high carbo-hydrate
content

36.  Hemorrhage
 Marginal ulcers
 Alkaline reflex gastritis
 Nutritional deficiency ( Vitamin B12 and folic
acid deficiency)

37.  The likelihood of recurrence is reduced if the
patient avoids smoking, coffee (including
decaffeinated coffee) and their caffeinated
beverages, alcohol, and ulcerogenic
medications (eg, NSAIDs)

39.  Acute pain related to incresed gastric secretions
,decresed mucosal protection ,and ingestion of
gastric irritants as evidenced by burning cramp
like pain in epigastrium and abdomen
 Nausea related to acute exacerbation of disease
process as evidenced by episodes of nausea and
vomiting
 Ineffective therapeutic regimen management
related to lack of knowledge of long term
management of peptic ulcer disease and
consequence of not following treatment plan and
unwillingness to modify lifestyle as evidenced by
frequent questions about home care incorrect
response to questions about peptic ulcer disease

40. ◦ Hemorrhage
◦ Perforation
◦ Penetration
◦ Pyloric obstruction (gastric outlet obstruction)

41.  RELIEVING PAIN
 REDUCING ANXIETY
 MAINTAINING OPTIMAL NUTRITIONAL STATUS
 MAINTAINING OPTIMAL NUTRITIONAL STATUS
 TEACHING PATIENTS SELF-CARE

42.  Hemorrhage
 Perforation and Penetration
 Pyloric Obstruction