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Peptic Ulcer Disease
A peptic ulcer is an ulcer of one of those areas of the gastrointestinal tract that are usually acidic.
Helicobacter pyroli , a spiral shaped bacterium that lives in the acidic environment of the stomach is associated with most ulcer cases. Ulcers can also be caused or worsened by drugs such as aspirin and NSAIDs.
More peptic ulcer arise in the duodenum than in the stomach.
About 4% of the stomach ulcers are actually caused by a malignat tumour, doudenal ulcers are generally non-malignant.
> Gastric ulcer(stomach)
> Duodenal ulcer(duodenum)
>Esophageal ulcer (esophagus)
> A Meckel's diverticulum.
> Abdominal pain, duodenal ulcers are classically relieved by food, while gastric ulcers are exacerbated by it.
> Bloating and abdominal fullness
> waterbrash(bitter regurgitation).
>Nausea, and sometimes vomitng.
> Loss of weight and appetite.
>Hematemesis (vomiting of blood)
>Melena ( foul,smelling faeces due to oxidised iron from hemoglobin
> ulcer can lead to agastric perforation, rarely. this is extremely painful and requires an immediate surgery.
STRESS AND ULCERS
There is a solid evidence that psychological stress triggers many ulcers and impairs response to treatment.
Psychological stress probably functions as a cofactor with Helicobater pyroli.
I t may act by stimulating the production of gastric acid or by promoting behaviour that causes a risk to health.
The possibility of other causes of ulcers like gastric cancer should be kept in mind, especially in ulcers of the large curvature of the stomach.
The most effective treatments when H.pyroli infection is diagnosed are the combination of 2 antibiotics ( e.g Erythromycin,Ampicillin, Tetracycline,Amoxicillin,Metronidazole and 1 proton pump inhibitor.
Amoxicillin and Metronidazole and pantroprazole gives a very effective combinatiion.
Perforated peptic ulcer is a surgical emergency and requires surgical repair of the perforation.
Most bleeding ulcers reqire endoscopy urgently to stop bleeding with cautery or injection.