Chapter 24. Stomach and Duodenum Diseases
Sections 3. Peptic Ulcer Diseases ★★★★★ • 3.1 Duodenal ulcer • 3.2 Gastric ulcer • 3.3 Hemorrhage from peptic ulcer • 3.4 Pyloric obstruction due to peptic ulcer • 3.5 Perforated peptic ulcer
Pathogenesis_Helicobacter pylori infection • 90% of DUs and approximately 75% of GUs are associated with H. pylori infection. • When this organism is eradicated as part of ulcer treatment, ulcer recurrence is extremely rare. National Institutes of Health Consensus Panel Recommendations for Helicobacter pylori Treatment
Pathogenesis_Helicobacter pylori infection • In the case of duodenal and gastric ulcers, Helicobacter pylori must colonize and weaken the mucosa before acid is able to do the damage, and therapy directed against this organism has a more definitive effect on the disease
Pathogenesis_Helicobacter pylori infection HELICOBACTER PYLORI GASTRITIS. Mild superficial gastritis results in erythema and prominence of the areae gastricae (as seen underwater). FOCAL HELICOBACTER PYLORI GASTRITIS. Patchy areas of inflammation in the proximal gastric body are well demarcated by the surrounding atrophic mucosa
Location and Type of Peptic Ulcer Diseases (PUDs) Location and Type of Ulcer • PUDs can be divided into 1. Gastric Ulcer (GU) 2. Duodenal Ulcer (DU). • PUDs occur near mucosal junctions. • DU usually occur at the duodenal pyloric junction, • GU tend to occur at the oxyntic-antral junction, the antral-pyloric junction, or the esophagogastric junction
Location and Type of GUs Type 1 GU most common(60%~70%). Typically, located on the lesser curvature at or proximal to the incisura, near the junction of the oxyntic and antral mucosa. Most are associated with diffuse antral gastritis or multifocal atrophic gastritis. Type 2 GU (~15%) occur in the same location as the type 1 lesion but are associated with either active or chronic duodenal ulcer disease. Type 3 GU (20%) are typically located within 2 cm of the pylorus (pyloric channel ulcer). Type 4 GU rare, is located in the proximal stomach or in the gastric cardia
A, Location of type 1 gastric ulcer. B, Location of type 2 gastric ulcer. C, Location of type 3 gastric ulcer. D, Location of type 4 gastric ulcer. (From Kauffman G Jr, Conter R: Stress ulcer and gastric ulcer. In Greenfield LJ, Mulholland MW [eds]: Surgery: Scientific Principles and Practice. Philadelphia, JB Lippincott, 1993.)
Clinical Manifestations 1. Abdominal pain 2. Bleeding 3. Perforation 4. Obstrction
3.1 DU_Essentials of Diagnosis • Epigastric pain relieved by food or antacids. • Epigastric tenderness. • Normal or increased gastric acid secretion. • Signs of ulcer disease on upper gastrointestinal x-rays or endoscopy. • Evidence of Helicobacter pylori infection