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Peptic ulcer
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Peptic ulcerRustanov A.
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Anatomical sections of thestomach and duodenum
• and 4 divisions
of duodenum,
upper
horizontal
lower
horizontal,
descending
and ascending
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GASTRIC TOPOGRAPHY• Location: not an intraperitoneal organ.
• The ligaments are superficial:
The ligaments are deep:
Lig.gastrocolicum
Lig.gastropancreaticum
Lig.gastrolienale
Lig.pyloropancreaticum
Lig.gastrophrenicum
Lig.hepatogastricum
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GASTRIC BLOOD SUPPLYFrom the truncus coeliacus system: a.gastrica sinistra et a.gastrica
dextra;
a.gastroepiploica dextra et a.gastroepiploica sinistra.
From the splenic artery aa.gastricae breves (3-6).
The venous outflow is through the veins of the same name into the
v.porta system.
Feature: There are 2 arterial arches (small and large curvature)
that anastomose with each other + aa.gastricae breves.
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GASTRIC INNERVATION• Parasympathetic-
1.n.vagus sin. along the front
wall
2.n.vagus dext. - behind
Sympathetic-• from the plexus coeliacus
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Physiology2-3 The lining cells secrete hydrochloric acid, which:
- Creates an optimum pH for the stomach,
- It is one of the regulators of gastric motility,
- It has a bactericidal effect,
4 Gastrin through the lining cells - increases the volume
and concentration of HCL.
Somatostatin - inhibits hydrochloric acid production
2-3 The main cells secrete an enzyme - Pepsin. It
provides the process of protein substrate breakdown.
1-4 (2-3 ) Parietal cells produce a mucus-like secretion
that covers the entire mucosa and protects it from the
effects of digestive enzymes and from mechanical
damage from coarse food.
gastric function: 1 secretion of hydrochloric acid, hormones, protective mucus
2 digestion - protein breakdown
3 Absorption- water and alcohol can be absorbed, some drugs
4 motor function
5 bactericidal
6 participation in hematopoiesis
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DUODENUMСостоит из : луковицы, нисходящего, горизонтального и восходящего
отделов.
• Кровоснабжение:
A.pancreaticoduodenalis superior ) – делится на переднюю и заднюю.
A.pancreaticoduodenalis inferior (из a.mesenterica superior) – делится на
переднюю и заднюю.
• Вены следуют ходу артерий, вливаясь в систему v.porta.
• Лимфоотток: - передние и задние 12перстно- поджелудочные узлы;
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Peptic ulcer diseasePrimary chronic recurrent disease
of upper gastrointestinal tract
associated with circumscribed
ulcers within stomach and
duodenum
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Ulceris disruption of the mucosal integrity of the
stomach and/or duodenum leading to a
local defect or excavation due to active
inflammation
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Peptic Ulcers:Gastric & Dudodenal
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Aggressive factors• bad habits (smoking, alcohol)
• Stress (psychological and physical)
• H/Pylory
• Hyperproduction of HCL
• Prolonged use of NSAIDs and SAIDs
• After gastric surgery, trauma.
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Protecrive factors• Good regenerative function of epithelium
• Good blood supply to the stomach
• Protective bicarbonate mucus
• Prostaglandins
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Etiology• the cause of peptic ulcer disease is the
predominance of agressive factors over
protective ones.
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Epidemiology• Duodenal ulcers (5x) > gastric ulcers
• ♂ (4x) > ♀
• Urban resident > rural resident
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Locations of ulcers• Any area where pepsin and acid are present
• Prevailing locations
– Duodenum: duodenal bulb
– Stomach: over lesser curvature
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Johnson’s classification(according to site, clinical manifestations)
• I type – ulcers of lesser curvature of stomach
• II type – combined ulcers of stomach and
duodenum
• III type – ulcers of prepyloric part stomach
• IV type – ulcers of duodenum
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Forms(according to severity)
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Clinical featuresPAIN
LOCATION
TIME
CHARACTER
IRRADIATION
PAIN RELIEF
•Gastric ulcer: in the centre of or left to epigastrium
•Duodenal ulcer: to the right of midline in epigastruim
•Early: 0.5-1 h after meal, duration 1.5-2 hh, in gastric ulcers
•Late: 1.5-2 hh after meal, in duodenal and pyloric ulcers
•Nocturnal
•Pain of “hunger”: 6-7 hh after meal and ceased after meal
•Burning
•Gnawing
•Dull
•Cramplike
•Cardiac area
•Left scapula
•Thoracic part of spinal column
•Lumbar region
•Antacids
•Milk
•Meal
•After vomiting
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Clinical featuresDYSPEPSIA
HEARTBURN
• Related with gastroesophageal reflux
• After meal
BELCHING
• More common in gastric ulcers
NAUSEA &
VOMITING
• At the peak of pain
• More common in gastric ulcers
• Pain relief after vomiting
APPETITE
• Excessive
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Laboratory and instrumentalexamination
CBC
• Hb
• Erythrocyte
Endoscopy
• Round or oval
• Edges: sharp,
hyperemic,
edematous
X-ray
(Barium meal)
• Niche sign
• Retention of barium
meal
• Duodenogastric reflux
• Local spasm of
stomach
•Biopsy
•Test with Insulin
•Test with Histamine
•pH meter
•Gastrin concentration in serum
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Diagnosis of Helicobacter pyloriinfection
• Invasive( through endoscopy)
– Gastric biopsy and staining
– Culture of biopsy specimen
– Tests using urease enzyme in biopsy specimens
• Non-invasive:
– Urea breath test
– H.pylori antibodies
– Stool antigen
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Peptic Ulcers:Gastric & Dudodenal
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• В развитии язвы желудка основными факторами являютсятрофические нарушения в стенке желудка, расстройства
микроциркуляции и инфекционный фактор - Helicobacter pylori
(НbР). Эта бактерия является причиной развития хронического
гастрита и язвенной болезни желудка и двенадцатиперстной
кишки.
• По локализации язвы:
• 1. Желудок: кардиальная и субкардиальная часть, малая
кривизна, большая кривизна, тело желудка, передняя и задняя
стенка, антральная часть.
• 2. Двенадцатиперстная кишка: луковица, постбульбарный
отдел, передней, задней, верхней, нижней стенок.
• 3. Сочетанные язвы желудка и ДПК.
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Рентгеноскопия желудка27.
Treatment28.
• how to deal with aggressive factors and howto help the protective factors we will talk in
practice class