PEPTIC ULCER DISEASE

PEPTIC ULCER DISEASE

Peptic ulcer disease is a break in the inner lining of the stomach or small intestine.

• An ulcer in the stomach called as GASTRIC ULCER
• while first part of the intestine called as DUODENAL ULCER

peptic ulcer disease is of two types - 1. TYPE A GASTRITIS
                                                           2. TYPE B GASTRITIS





1.TYPE A GASTRITIS

• Autoimmune disorder, premalignant ulcer
• Anti parietal cell antibodies
• Achlorhydria (gastric ulcer)
• Intrinsic factor lesser, B12 deficiency (macrocytic anemia)

GASTRIC ULCER: common in BLOOD GROUP A, most common site : LESSER CURVATURE , pain : EPIGASTRIC PAIN (immediately after food intake) , weight loss

endoscope - gastric ulcer

DUODENAL ULCER: common in BLOOD GROUP O , most common site : DUODENAL CAP , pain : EPIGASTRIC PAIN , weight gain



JOHNSON CLASSIFICATIONS
 Types of ulcers by johnson classifications

IOC: UPPER GI ENDOSCOPY  +  BIOPSY


2.TYPE B GASTRITIS
   - HELICOBACTER PYLORI

• gram negative coccobacilli
• microaerophilic
• spread : feco - oral route
• non spore forming so eradication possible
• extra cellular bacteria
• produce enzyme urease

 urea break down to ammonia in presence of urease which irritation of G cells/ PARIETAL cells which results acid production that cause ulcer (duodenal ulcer)

WORKUP:

1. Screening test / eradication - Breath urea test
2. Urease test(CLO TEST) : invasive test - scraping wall of stomach
3. Biopsy: warthin starry stain used

TREATMENT:
  Antibiotics

Triple therapy

1. pantoprazole 
2. clarithomycin (2 weeks)
3. amoxicillin (2 weeks)

Quadruple therapy

1. Bismuth
2. Tetracycline
3. metronidazole
4. pantoprazole

COMPLICATION:

complications in gastric ulcer:

1.BLEEDING; Left gastric artery
                       
             upper GI endoscopy

             Do "cautery" if fails "ligation of bleeder"



2. PERFORATION: Lesser sac


3.PENETRATION:slow, posterior
             causes - pseudo pancreatic cyst
                        - necrotizing pancreatitis


4.MALIGNANCY


5.HOUR GLASS STOMACH: fibrosis



complications in duodenal ulcer

1. PERFORATION: anterior  > posterior
                                      gas under diaphragm - known as - cupola sign , moustache sign


2. BLEEDING: posterior > anterior
           
                       source - Gastroduodenal artery
     
                       management - Adrenaline at base of ulcer
                                            - cautery , ligation , exploratory laparotomy

3. SIGMOID VOLVULUS:
                    
                       Large bowel obstruction

                          1. sudden onset left iliac fossa crampy pain
                          2. obstipation (can't pass flatus)
                                   anti clockwise direction
                                             - x - ray abdomen: coffee bean appearance
                                             - Barium enema: bird beak appearance
                                   management: 1. intravenous fluids
                                                          2. flatus tube
                                                          3. colonoscopic detorsion




PRE - MALIGNANT CONDITIONS OF GUT

1. ORAL CAVITY:
                - Leukoplakia ; more common
                - Erythroplakia : more malignant

2. ESOPHAGUS:
                - Tylosis palmaris: Hyperkeratosis in palms and soles
                - Plummer vinson syndrome: esophageal web , IDA (iron deficiency anemia)
                - Barrett's esophagus
                - Achalasia cardia

3. STOMACH:
                - Type A gastritis
                - gastric ulcer
                - menetrier's disease

4.SMALL INTESTINE
                - Crohn's disease
                - Cronkhite canada syndrome ; polyp in duodenum

5. LARGE INTESTINE
           Familial adenomatous polyposis(FAP)
               - APC gene
               - chromosome 5
               - > 100 polyps/colon
               - primary colectomy
 
           Inflammatory bowel disease




condition where polyps themselves are not premalignant but a definite association between gut malignancy seen :

PEUTZ JEGHERS SYNDROME

• Hemartomatous polyps in jejunum that lead to bleeding obstruction and intussusception
• STK gene
• most common site : jejunum
• mucosal melanosis of lips/anus
• not a premalignant condition or least likely to turn malignant