Predisposing Factors

Duodenal: -Age 30-60 -Male:Female 4:1 -Blood Type O Gastric: -Age above 50 -Male:Female 2:1

Precipitating Factors Etiology Duodenal: NSAIDs Helicobac ter pylori Stress Aclohol Diet Smoking

Ingestion of Helicobacter pylori from infected food

Overuse of Non- Steroidal Inflammatory Drugs (NSAIDs)

H. pylori invades the mucosal layer of the GI wall of the duodenum

Inhibits the enzyme cylcooxygenase 1 (COX1)

H. pylori releases urease

Decrease synthesis of prostaglandins

Urease catalyze urea to ammonia

Decrease mucous production in the mucous membrane of the GI wall/ lining

Ammonia will neutralize gastric pH Decrease mucosal defenses

H. pylori invades the epithelial cells (parietal cells)

Gastric acid damages the GI wall/ lining

increase gastric acid production from parietal cells

Gastric acid damages the mucosal layer

DUODENAL ULCER
Signs and Symptoms Duodenal Ulcer: epigastric pain Weight gain melena Gastric Ulcer: epigastric pain Epigastric fullness nausea vomiting loss of appetite weight loss hematemesis

GASTRIC ULCER

Treatment Duodenal: relieve by food ingestion Gastric: avoid food ingestion Diet: y Eat 5 to 6 small meals a day instead of 3 larger meals. It is important that you avoid overeating. Frequent, smaller meals will be more comfortable and easier on the stomach than two or three large meals a day. y Eat a diet rich in fiber, especially from fruits and vegetables y Rest and relax a few minutes before and after each meal, as well as remaining relaxed during meals. y Eat slowly and chew you food well y Avoid eating within 3 hours before bedtime y Eat foods that are low fat y Avoid foods that are fried y Avoid foods that are spicy y Avoid alcohol y Quit smoking

Drugs y y y y y y y Histamine receptor antagonists (Ranitidine) Antiulcer agents (Sucralfate) Proton Pump Inhibitor (omeprazole) Anticholinergics (atropine) Analgesics (morphine sulfate) Macrolides (Clarithromycin) Aminopenicillins (Amoxicillin)

Diagnostic Tests Endoscopy /biopsy Upper gastrointestinal series y Gastric analysis For H. pylori: y Blood test for H. pylori antibodies. y Urea breathe test. y Stool antigen test. y Biopsy of the stomach lining. y y

if not treated

Gastric contents enters to the submucosal layer

scarring of the pylorus

Perforation

Inflamed pylorus

Gastric contents (gastric acid, pepsin, bile, pancreatic juices) enters to abdominal cavity

Surgical Interventions Peritonitis yVagotomy yTruncal vagotomy ySelective vagotomy yPyloroplasty yBilroth 1 and 2

Pyloric Obstruction (gastric outlet obstruction)