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Izatty Lim
0308188
Batch 4

 defined as having one or more symptoms of
epigastric pain, burning, postprandial fullness, or
early satiety.
 Bloatin...

PUD

 Type I
 typically located near the angularis incisura on the lesser
curvature, close to the border between the antrum...
 Etiology:
 H. pylori bacterium
 NSAID
Gastric Ulcer
 H. pylori
 70% of gastric ulcer patients are infected with H. pylori.
Majority of colonised people remain healthy and
...

 NSAID
 Direct chemical irritation & COX enzyme inhibition,
which prevent prostaglandin synthesis
 increases secretio...

 Smoking
 Increased risk of gastric ulcer and duodenal ulcer to a
lesser extent.
 more likely to causing complication...

 recurrent abdominal pain
 localisation to the epigastrium
 Relation to food
 Episodic occurrance
 Occasional vomit...

 Upper GI endoscopy
 Rapid urease tests
 Fecal antigen testing
 detecting the presence of H pylori antigens in stool...

 H. pylori eradication
 proton pump inhibitor (PPI)–based triple therapy.
 PPI, amoxicillin, and clarithromycin for 7...

 Surgical
 Rarely required
 Choice for a chronic non-healing gastric ulcer
 partial gastrectomy to exclude an underl...

 Duodenal ulcer and gastric ulcer both belong to the
family of peptic ulcer disease.
 H. pylori infection is the major...

 Gastric Ulcer
 Symptoms do not
follow a consistent
pattern
 Eating sometimes
exacerbates rather
than relieves pain
G...

Complication
Stricture
•Gastric outlet
obstruction
•Abdominal distension
•Nausea, vomiting
•Diagnosis by visible
gastric...

 Harmon RC, Peura DA. Evaluation and Management of
Dyspepsia [Internet]. Medscape. [cited 2015 May 24]. Available
from:...
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Dyspepsia- Peptic Ulcer Diseases

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What is dyspepsia?
Peptic Ulcer Diseases - Site, Pathophysiology, Clinical feature, Investigation, Treatment

Publié dans : Santé & Médecine
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Dyspepsia- Peptic Ulcer Diseases

  1. 1. Izatty Lim 0308188 Batch 4
  2. 2.   defined as having one or more symptoms of epigastric pain, burning, postprandial fullness, or early satiety.  Bloating  Nausea  Loss of appetite Dyspepsia
  3. 3.  PUD
  4. 4.   Type I  typically located near the angularis incisura on the lesser curvature, close to the border between the antrum and the body of the stomach. Patients with type I gastric ulcers usually have normal or decreased gastric acid secretion.  Type II  a combination of stomach and duodenal ulcers and are associated with normal or increased gastric acid secretion.  Type III  prepyloric and are associated with normal or increased gastric acid secretion.  Type IV  occur near the gastroesophageal junction, and gastric acid secretion is normal or below normal. Types of Gastric Ulcer
  5. 5.  Etiology:  H. pylori bacterium  NSAID Gastric Ulcer
  6. 6.  H. pylori  70% of gastric ulcer patients are infected with H. pylori. Majority of colonised people remain healthy and asymptomatic.  uses adhesin molecules (BabA) to bind to Lewis b antigen on epeithelial cells.  induces an intense inflammatory and immune response  IL-1, IL-6, tumor necrosis factor, IL-8  Production of ammonia by the enzyme urease  Toxic to epithelial cell  Increase gastrin release from G cells  Negative feedback loop for gastrin release is halted  stimulates increased acid production by parietal cells. Pathophysiology
  7. 7.   NSAID  Direct chemical irritation & COX enzyme inhibition, which prevent prostaglandin synthesis  increases secretion of hydrochloric acid and reduces bicarbonate and mucin production  Damage gastric and duodenal mucosal barrier  increased risk of upper gastric ulcer, bleeding &perforation. Pathophysiology
  8. 8.   Smoking  Increased risk of gastric ulcer and duodenal ulcer to a lesser extent.  more likely to causing complication and less likely to heal if the patient continues to smoke. Pathophysiology
  9. 9.   recurrent abdominal pain  localisation to the epigastrium  Relation to food  Episodic occurrance  Occasional vomiting  Anorexia & nausea  Completely ‘silent’  presented with anaemia for the first time  Recurrent acute bleeding without ulcer pain  Gnawing or burning sensation  occurs shortly after meals with gastric ulcer and 2-3 hours afterward with duodenal ulcer.  Diagnostic value of individual symptoms for PUD is poor. Clinical Features
  10. 10.   Upper GI endoscopy  Rapid urease tests  Fecal antigen testing  detecting the presence of H pylori antigens in stools  Urea breath test  testing for the enzymatic activity of bacterial urease.  Antibodies (IgG)  X- ray  detect free abdominal air when perforation is suspected.  upper GI contrast study  extravasation of contrast indicates gastric perforation Investigation
  11. 11.   H. pylori eradication  proton pump inhibitor (PPI)–based triple therapy.  PPI, amoxicillin, and clarithromycin for 7-14 days.  Amoxicillin should be replaced with metronidazole in penicillin- allergic patients only  high rate of metronidazole resistance  NSAID  American College of Gastroenterology (ACG ) guideline: test for H pylori done in patients who started long-term NSAID therapy  NSAIDs should be immediately discontinued in patients with positive H pylori test results if clinically feasible  Patient with known history of ulcer and in whom NSAID use is unavoidable, the lowest possible dose and duration of the NSAID and co-therapy with a PPI or misoprostol are recommended. Treatment
  12. 12.   Surgical  Rarely required  Choice for a chronic non-healing gastric ulcer  partial gastrectomy to exclude an underlying cancer. Treatment
  13. 13.   Duodenal ulcer and gastric ulcer both belong to the family of peptic ulcer disease.  H. pylori infection is the major cause of duodenal ulcer followed by NSAID  They share almost the same clinical features. Duodenal Ulcer
  14. 14.   Gastric Ulcer  Symptoms do not follow a consistent pattern  Eating sometimes exacerbates rather than relieves pain Gastric Ulcer vs Duodenal Ulcer  Duodenal Ulcer  Tend to cause more consistent pain.  Pain can awaken the patient at night.  Pain is relieved by food, but recurs 2 to 3 hours after a meal
  15. 15.  Complication Stricture •Gastric outlet obstruction •Abdominal distension •Nausea, vomiting •Diagnosis by visible gastric peristalsis Perforation •Sudden severe pain then become generalized •Irritation of diaphragm leading to shoulder tip pain Peritonitis •Paralytic ileus •Absent bowel sound •Abdominal guarding
  16. 16.   Harmon RC, Peura DA. Evaluation and Management of Dyspepsia [Internet]. Medscape. [cited 2015 May 24]. Available from: http://www.medscape.com/viewarticle/721062_1  Robbins basic Pathology. 9th Ed.  BS Anand. Peptic Ulcer Disease Treatment & Management [Internet]. [cited 2015 May 24]. Available from: http://emedicine.medscape.com/article/181753- treatment#aw2aab6b6b1aa  Davidson’s Principle & Practice of Medicine. 22nd Ed. References

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