Peptic ulcer

Peptic ulcer refers to an ulcer in the lower oesophagus,stomoch or duodenum,in the jejunum after surgical anastomosis to stomoch n in ileum adjecent to a meckels divirticulum.
1 heredity
2 acid pepsin vesus mucosal resistance_cause of peptic ulceration is digestion of the mucosa with acid plus pepsin of gastric juice.
3 gastric hypersecretion is more important in etiology of duodenal ulcer.
4 other risk factor include smoking n alcohol consuption
clinical features_
it is chronic condition with natural history relapse n remission lasting for decade even life long.
The most common presentation is that of recurrent abdominal pain which has three notable characters_1 localisation to epigastrium  2 relation to food
3 periodicity.
Epigastric pain,burning in character.
Hunger pain,night pain r other features.

1 upper gastrointestinal bleed
2 perforation
3 gastric outlet obstruction
4 gastric malignancy
5 pancreatitis
1 double contrast barium meal may shows ulcer as crater or as deformed duodonal cap.
2 endoscopy can visualise the ulcer.A biopsy can b taken frm gastric ulcer to rule ot malignancy n H pylori infection.
3 test for H.Pylori.
A on endoscopic biopy_rapid urease test,histoly n culture.
B non invasive_serology for IgG,urea breath test.,H.Pylori stool antigen test.
4 serum gastrin n gastric acid analysis.
short term management-
1 general care_avoid smoking.,avoid aspirin n NSAIDs drugs.
Alcohol to b moderated,No spicy dietory advice.
2 Antacids-mainly prescribe for symptomatic relief.Sodium biocarbonate is the quickest acting antacid
3 histamine H2 receptor antagonist-includes Cimetidine,ranitidine,famotidine,n nizatidine
mechanism of action is inhibition of acid n pepsin secretion by blockhning H2 receptor.
Ranitidine 150mg BD,cimetidine 400mg BD.Duration of treatment for duodenal ulcer is 4wks n in gastric ulcer 6-8wks.
4 Proton pump inhibitors_
these includes Omeprazole,lansoprazole,pantoprazole n esmoprazole.
Mechanism of action is irriversible inhibitio of acid secretion by the proton pump.
Omeprazole_20mg BD daily for 4_8wks.
Indication_reflux oesophagitis n GERD.,peptic ulcer unresponsive to other medical measures.,zollingor ellison syndrome.
5 Prostaglandin analogues_ misoprostole 200microgram 4 times daily,useful in preventing NSAIDS induce mucosal injury.
6 colloidal bismuth subcitrate
7 Sucralphate 2g BD.
8 carbenoxolon sodium
9 treatment of H.Pylory_triple therapy omez,clarithromycine,metronidazole.
itermittent treatment for sympotomatic relapse.
Maintainanance treatment.
Surgical treatment-
for gastric ulcer_partial gastrectomy with Billroth1 anastomosis..
For duodenal ulcer_selective vagotmy with pyloroplasy,highly selective vagotomy.

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