Problems related to Digestive Tract is common because of our food in take. Peptic ulcer and duodenal ulcer is also among that. It occur due to improper production of gastric contents.

1. 1
PEPTIC ULCER
AND DUODENAL
ULCER
Presented By: Deeksha Sharma
M.Sc.Nursing 1st Year
Medical Surgical Nursing

2. 2
CONTENT
1. Anatomy and physiology of Gastrointestinal System
2. Introduction
3. Definition
4. Etiology/Risk Factor
5. Types
6. Pathophysiology
7. Clinical manifestation
8. Investigation/Diagnostic test
9. Management
10. Complications
11. Health Education
12. Summary
13. References

3. 3
Anatomy And physiology

4. 4

5. 5

6. 6

7. 7
INTRODUCTION
A peptic ulcer is an open sore that develops on
the inside lining of the stomach (a gastric
ulcer) or the small intestine (a duodenal ulcer).
The most common symptom of a peptic ulcer
is a burning a gnawing pain in the center of the
abdomen.

8. 8
DEFINITION
 Peptic ulcers are the open sores that
develop on the inside lining of the
esophagus, stomach and upper portion of
small intestine. It is characterized by
abdominal pain.
 Peptic ulcer is a lesion in the lining
(mucosa) of the digestive tract, typically in
the stomach or duodenum, caused by the
digestive action of pepsin and stomach.

9. 9
Lesion may subsequently occur
Into the lamina propria and
Sub mucosa to cause bleeding.
Most of peptic ulcer occur either
in the duodenum, or in
stomach. Ulcer may also occur
either in the lower esophagus
due to reflexing of gastric
content.

10. 10
CLASSIFICATION
 By Region
1. Duodenal Ulcer
2. Esophageal ulcer
3. Gastric ulcer
4. Meckel’s diverticulum

11. 11
Duodenal ulcer

12. 12
Esophageal ulcer

13. 13
GASTRIC ULCER

14. 14
Meckel’s Diverticulum:

15. 15
Modified Johnson
Classification
 Type I: Ulcer along the body of the stomach,
most often along the lesser curve
 Type II: Ulcer in the body in combination with
duodenal ulcers.
 Type III: In the pyloric channel within 3cm of
pylorus.
 Type IV: Proximal gastro esophageal ulcer.
 Type V: Can occur throughout the stomach.

16. 16

17. 17
Etiology
 Helicobacter pylori
 NSAIDS
 Acid and Pepsin
 Smoking
 Caffeine
 Alcohol
 Stress
 Lifestyle

18. 18
Characteristics
Characteristics Peptic ulcer Duodenal ulcer
Incidence Age: 50 years or above
Male : female (1:1)
15% of peptic ulcers are
gastric.
Age: 30-60 years
Male : Female (2-3:1)
80% of peptic ulcers
are duodenal.
Definitions Ulcers that occur in the
stomach are called gastric
ulcers.
The duodenum ulcer
refers to the upper
region of the small
intestine.
Causes H. Pylori
NSAIDS
Excess stomach acid
H.pylori
Sign and
Symptoms
Gastric ulcer causes
stomach pain immediate
and 1-2 hours after eating.
Duodenal ulcer
causes pain 3-4 hours
later

19. 19
Located in epigastric area
Burning
Vomiting is common
Normal and hypo
secretion of HCL
Pain tends to develop or
worsen when the stomach
is full.
Pain below the ribs
and just below the
breastbone
Aching, burning,
hunger-like pain in
upper-middle portion
of the abdomen
No vomiting
Hypersecretion of
HCL
Pain tends to
develop or worsen
when the stomach is
relatively empty.
Malingnancy
possibility
Rare Occasionally
Risk Factors Alcohol, smoking,
cirrhosis, stress
NSAIDS, gastritis,
alcohol, smoking
Diet A gastric ulcer has a Duodenal ulcers do

20. 20
Pathophysiology
 Duodenal Ulcer:
H. Pylori infection and duodenitis
Impaired duodenal bicarbonate secretion and moderate increases
in acid and peptic activity
Decreased duodenal buffering capacity
Increased mucosal injury
Gastric metaplasia
cont……

21. 21
In presence of antral H. Pylori the gastric metaplasia can become
colonized and inflamed
Ulceration
Increased inflammation with loss of the framework for regeneration
Cause a chronic ulcer

22. 22
Gastric Ulcer:
Decreased acid-peptic activity
Causes mucosal defensive impairments
Leads to combination of inflammation, protective deficiencies and
moderate amounts of acid and pepsin
Induces ulceration

23. 23
Clinical Manifestation
 Abdominal Pain/ epigastric pain
 Heart burn- retrosternal burning discomfort (Pyrosis)
 Bloating and abdominal fullness
 Waterbrash
 Nausea and copious vomiting
 Loss of appetite and weight loss
 Hematemesis
 Melena
 Peritontis
 Heart burn and chest discomfort
 Flare at night
 Hemoptysis
 Constipation or diarrhea

24. 24
Peptic Ulcer Duodenal Ulcer
Occur in the stomach Occur in the duodenum
Epigastric pain 1-2 hours after
eating
Epigastric pain 2-5 hours after
eating
Can cause hematemesis or
melena
Can cause melena or
hematochezia
Heart burn, chest discomfort Heart burn, chest discomfort are
less common but may be seen
Can cause gastric carcinoma Pain may awaken patient during
the night

25. 25
Diagnostic Evaluation

26. 26
 History Collection
 Physical Examination
 Medical history
 Laboratory test
1. Blood test
2. Urea Breath test
3. Stool Test
4. Tissue Test
5. Serologic test for detecting H. Pylori

27. 27
 Esophagogastrodeuodenoscopy

28. 28
Management
 Goals:
1. Relief from pain
2. Promotion of ulcer healing
3. Prevention of complications
4. Prevention of relapse

29. 29

30. 30
 Antacids: Maalox, Mylanta.
 H2 Blockers:-
1. Cimentidine
2. Ranitidine
3. Nizatidine
4. Famotidine
 Proton-Pump Inhibitors:-
1. Omeprazole
2. Pantoprazole
3. Esomeprazole
4. Rabeprazole

31. 31
 Sucralfate and Misoprostol
 H. Pylori Treatment: Treatment require a combination
of several antibiotics with a proton-pump inhibitors, H2
blockers.
 Antibiotics:-
1. Tetracycline
2. Amoxicillin
3. Metronidazole
4. Clarithromycin
5. Levofloxacin.

32. 32
 Probiotic supplement
 Vitamin C
 Herbs
 Cranberry

33. 33
Non Pharmaceutical
Treatment
 Reduce psychological stress.
 Reduce physical stress.
 Cessation of cigarette smoking.
 Stop use of NSAIDS.
 Avoid spicy foods, caffeine, alcohol.
 Drink plenty of water.
 Avoid fasting and maintain optimum gap between meals.

34. 34
Surgical Management
 Vagotomy

35. 35
 Truncal Vagotomy

36. 36

37. 37
 Selective Vagotomy

38. 38
 High selective vagotomy:

39. 39
 Antrectomy

40. 40
 Billroth-I

41. 41
 Billroth-II

42. 42
 Pyloroplasty

43. 43
Gastrectomy

44. 44

45. 45
Complication
 Gastrointestinal Bleeding
 Perforation
 Penetration
 Gastric outlet obstruction
 Dumping syndrome

46. 46

47. 47
 Foods containing flavonoids, like apples, celery,
cranberries may inhibit the growth of H. Pylori.
 Eat foods high in vitamin B and calcium
 Avoid refined foods.
 Eat fewer red meats and more lean meats, cold water
fish, tofu.
 Reduce or eliminate trans-fatty acids.
 Avoid beverages that may irritate the stomach lining or
increase acid production .
 Drink 6-8 glasses of filtered water daily.
 Exercise at least 30 minutes daily, 5 days a week.

48. 48

49. 49
1. Acute pain related to irritation of the mucosa and
muscle spasms.
2. Imbalanced nutrition less than body requirement
related to ulceration of stomach.
3. Vomiting related to indigestion of food.
4. Loss of weight related to less intake of nutrients
secondary to peptic ulcer.
5. Anxiety related to the nature of the disease and long
term management.
6. Knowledge deficit related to treatment regimen.

50. 50