PEPTIC ULCER

DISEASE
(revised)
RN

Peptic Ulcer Disease

ULCER craterlike lesion in a membrane

Ulcers that develop in areas of the GIT exposed to acidic

gastric juice are called PEPTIC ULCERS
Erosions vs True Ulcers

PUD - can develop in the lower esophagus, stomach,

duodenum, or jejunum

TWO MAJOR FORMS

Duodenal Ulcer

affect the upper part of the small intestines

accounts 80% of PUD

Gastric Ulcer

affects stomach lining

common in middle-aged & elderly esp. poor &

malnourished

common in chronic users of ASA & ROH

Etiology : UNKNOWN
MAJOR CONTRIBUTORS
Campylobacter pylori

Urease splits the urea into ammonia and

CO2

Catalase

Adhesion proteins

MAJOR CONTRIBUTORS
Non-steroidal anti-inflammatory drugs

inhibits prostaglandin, decrease mucus

production

Hypersecretory states / Inadequacy may also

contribute

Contributing factors

Personal type A & Blood Type O

Genetic predisposition

Tobacco use

Ingestion of food or drugs

Stress

PATHOPHYSIOLOGY
BILE SALTS, ASPIRIN, ALCOHOL,
ISCHEMIA
DAMAGED MUCOSAL BARRIER
DEC. FXN OF MUCOSAL CELLS
DEC. QUALITY OF MUCUS
LOSS OF TIGHT JUNCTIONS BET. CELLS
BACK-DIFFUSION OF ACID INTO GASTRIC
MUCOSA
PEPSINOGEN
PEPSIN

FURTHER MUCOSAL
EROSION
ULCERATION

^ HCl ACID
PRODUCTION

FORMATION AND
LIBERATION OF
HISTAMINE

burning, gnawing, or
cramplike pain
epigastric
tenderness
voluntary muscle
guarding

ULCERATION OF MUCOSA
(GASTRIC / DUODENAL)

NO TXMENT?

CONTINUOUS EROSION OF
MUCOSA

s/sx:
hemate
mesis
melena
anemia

Erosion of the
ulcer into an
artery or vein

Perforation of the
mucosal wall

Scarring and swelling of

the mucosa

Gastrointestinal
bleeding

Spillage Gastric
enzymes and bolus
into abdominal cavity

Peritonitis and pancreatitis

Massive blood
loss

Narrowing in the
duodenum and/or
near pyloric canal
Gastric outlet
obstruction

Sepsis

shock
Septic shock

DEATH

Distention and tissue

damage

WHAT TO LOOK FOR ?

GASTRIC ULCER

recent loss of weight

heartburn, indigestion, sharp

abdominal fullness

DUODENAL ULCER

burning pain

recent weight gain

Diagnostic Tests
Barium Swallow / UGIS / Small Bowel
Series
GI Endoscopy /
Esophagogastroduodenoscopy
> Biopsy and histology with culture
Stool exam and occult blood
WBC Count
Gastric secretory studies
Carbon-13 Urea Breath Test

Management
combination of antibiotics, proton pump inhibitors,
histamine (H2) receptor antagonist
antacids
gastric aspiration
stress reduction and rest
smoking cessation
dietary modification

SURGICAL MGT

Total Gastrectomy / Esophagojejunostomy

Vagotomy surgical division of the vagal nerve

Gastric resection / antrectomy

Billroth I / Billroth II

Pyloroplasty

Dumping Syndrome
rapid emptying of the gastric contents into the small
intestine
Symptoms : usually occur 30 mins pc

abdominal cramping

diarrhea

palpitations

tachycardia