Lectures Peptic ulcer diseas - Trần Ngọc Anh

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Lecture Peptic ulcer diseas helps learners describe clinical symptoms of stomach ulcer duodenal typical; understanding the pathophysiology of gastric ulcer and duodenal role of HP; describes the diagnostic steps duodenal peptic ulcer; mentioned is the use of medicine in gastric duodenal ulcers.

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Nội dung Text: Lectures Peptic ulcer diseas - Trần Ngọc Anh

PEPTIC ULCER DISEASE Peptic ulcer diseas-Tran Ngoc Anh MD
1.Recognize the typical clinical presentation and risk factor for Objectives PUD 2.Understand pathophysiology of PEPTIC PUD focusing on HP ULCER 3.Describe an appropriate DISEASE diagnostic plan 4.Prescribe an appropriate therapeutic regime Peptic ulcer diseas-Tran Ngoc Anh MD
GENERAL CONSIDERATIONS  An ulcer: disruption of the mucosal integrity of the stomach and/or duodenum (surface >5mm in size, depth to the submucosa)  Occur: Stomach and/or duodenum  Chronic Peptic ulcer diseas-Tran Ngoc Anh MD
ETIOLOGY and PATHOPHYSIOLOGY Common Rare Uncommon • Helicobacter • Zollinger • Crohn’s pylori Ellison disease infection • Tumors (Cancer, • Helicobacter • NAIS lymphoma) helimannil • Stress- • Viral infections • Idiopathic related • Radiation/che mucosal motherapy damage • Vascular insufficiency Peptic ulcer diseas-Tran Ngoc Anh MD
ETIOLOGY and PATHOPHYSIOLOGY
CLINICAL FEATURES 1.Symptoms -Abdominal pain. 10%PU with a complication: bleeding, perforation, obstruction -Epigastric pain-Most common subtype: burning, gnawing discomfort: +DU: occurs 90 min to 3h after a meal; relieved by antacids or food. Awakes from sleep +GU: discomfort precipitated by food -Nausea, Weight loss; more commonly in GU -Dyspepsia including belching, bloating Peptic ulcer diseas-Tran Ngoc Anh MD
CLINICAL FEATURES  Common risk factor for gastric mucosa disruption: HP, NSAIDS/ASA(event at low dose), Coffe caffeine, Ethanol, Tobacco, Severe Physiology stress, Steroids  Clinical pearls: NSAID: gastritis or ulcer silent. Ve Dyspeptic are non specific: 20-25%  NSAIDS: 15%of patients longterm NSAIDS (Piroxicam, Feldene, Ketorolac, Toraldo, Celceb, Indomethacine, Ibuprofen, Selective COX2) Peptic ulcer diseas-Tran Ngoc Anh MD
CLINICAL FEATURES 2.Physical examination: few, non specific Epigastric tenderness (20% in right of the midline) Discovering evidence of ulcer complication Tachycardia, orthostasis: dehydration secondary to vomiting, active gastrointestinal blood loss Severely tender, Boardlike abdomen: perforation Succussion splash indicates retained fluid in the stomach: gastric outlet obstruction Peptic ulcer diseas-Tran Ngoc Anh MD
CLINICAL FEATURES • Epigastric pain • Nausea Typical • Fullness, Bloating symptoms • Early satiely • Nocturnal pain • Anemia • Hematemesis, Melena, Alarm Heme+ stool symptoms • Anorexia, weight los • Severe abdominal pain Peptic ulcer diseas-Tran Ngoc Anh MD
LABORATORY FINDING Radiographic-Barium study Endoscopy Others Peptic ulcer diseas-Tran Ngoc Anh MD
LABORATORY FINDING 1.Barium studies -Older single contrast barium meals: 80% Double :90% -Not good in small ulcer -DU: Well demarcated crater in the bulb -GU: discrete with radiating mucosal folds origanating from the ulcer margin -Ulcer >3cm with mass: malignant Peptic ulcer diseas-Tran Ngoc Anh MD
LABORATORY FINDING
LABORATORY FINDING 2.Endoscopy  Most sensitive, specific  Permet: direct visualization of the mucosa, tissue biopsy-rule out malignancy, H.pylori 3.Others -CBC: acute/chronic blood loss -HP test Peptic ulcer diseas-Tran Ngoc Anh MD
LABORATORY FINDING
LABORATORY FINDING Test Se/Sp Comments Invasive Rapid urease 80-95/95-100 Simple, False (-) with PPI, Antibiotics, Bismuth Histology 80-90/.95 Require pathology processing and staining, provides histologic information Culture Time consuming, expensive, dependent on experience, allows determination of antibiotic susceptibility Non invasive Serology >80/>90 Inexpensive, convenient, not useful for early follow up Urea breath >90/>90 Simple, rapid; useful for early follow up, test False (-) with PPI, Antibiotics, Bismuth Stool antigen >90/>90 Inexpensive, convenient; not establishd for eradication but promising Peptic ulcer diseas-Tran Ngoc Anh MD
COMPLICATIONS Gastrointestinal Gastric outlet Perforation bleeding obstruction Peptic ulcer diseas-Tran Ngoc Anh MD
COMPLICATIONS 1. Gastrointestinal bleeding: Most common  15%, >60; Use NSAIDS  Tarry stools, coffe ground emesis; 20% without any preceding warning signs or symptoms 2.Perforation: Second most commonly  6-7%, elderly, NSAIDS  Sudden onset of severe, generalized abdominal pain  Penetration- -DU: Pancreas pancreatitis -GU: Left hepatic lobe Peptic ulcer diseas-Tran Ngoc Anh MD
COMPLICATIONS 3.Gastric outlet obstruction  The least common complication  1-2% patients  Pain worsening with meal, nausea, vomiting of undigested food. Weight loss Peptic ulcer diseas-Tran Ngoc Anh MD
TREATMENT • Acid neutralizing/inhibitory drugs INTERNAL • Cytoprotective agents MEDECINE • Therapy of H.Pylori • Therapy of NSAID related gastric or duodenal • Fail of internal medecine SURGICAL • Complication Peptic ulcer diseas-Tran Ngoc Anh MD
TREATMENT Acid neutralizing/inhibitory drugs Proton Pump Antacids H2 antagonists (H+K+ATPase) • Mix . Aluminum, • Use primarily in • ↓gastric acid Mg hydroxide UD not secretion by • Maalox, associated with inhibiting the Gastropulgite HP parietal • Inhibit the H2 cellH+K+ATPase receptor of • Relieve pain, parietal cell heal PU more →reduced acid rapidely than H2 secretion(basal , • Before a meal stimulated) • Duration 4w • Once/day- bedtime • Duration: 6-8w Peptic ulcer diseas-Tran Ngoc Anh MD