Peptic Ulcer Disease PUD

*Duodenal Ulcers (DU)

-Commoner than GU / M > F / The M.C pathophysiologic mechanism of DU is primarily related to (Gastric acid hypersecretion)

-inc.gastric acid secreation / inc.gastric empyting / dec. duodenal pH

-Risk factors :

.h.pylori

.drugs (aspirin,NSAIDs,steroids)

.blood group O

.smoking

.cancer of stomach

.zollinger-ellison syndrome

.crohn disease

.head truma

.hyperparathyroidism

.chronic pulmonary insuff.

-Symptoms :

.mid-epigastric pain,tenderness typically before meals pr at night,relieved by eating or drinking milk

.nausea & vomiting

-Diagnosis :

.upper GI endoscopy

*Gastric Ulcer (GU)

-Occur mainly on the elderly / GU may become malignant (DU are not)

-Risk factors :

.H.pylori

.smoking

.NSAIDs

.reflux of deudenalcontents

.delayed gastric emptying

.stress

.alcohol

.neurosurgery (cushing`s ulcers)

-Symptoms :

.asymptomatic or epigastric pain

.weight dec.

-Diagnosis :

.upper GI endoscopy

.biopsies from the ulcer`s rim and base

-Drugs are used in the treatment of duodenal ulcer :

.sucralfate

.sismuth

.sirazepine

.H2-receptors antagonists

+H. pylori can lead to :

.MALT lymphoma

.gastric ulcers

.duodenal ulcers

.gastric cancer

+Drugs are used in the management of peptic ulcer disease :

.Famotidine

.Sucralfate

.Omeprazole

.Anticholinergic drugs

.Ranitidine

.Cimetidine

+Drugs are used for H. pylori eradication :

.Tetracycline

.Metronidazole

.Clarithromycin

.Amoxicillin

+Cimetidine is a selective H2 receptor blocker which inhibits gastric secretion

**Inflammatory Bowel Disease (IBD)

-Is a group of inflammatory conditions of the colon and small intestine. Crohn's disease and ulcerative colitis are the principal types of inflammatory bowel disease.

*Crohn`s Disease CD

-Is a type of inflammatory bowel disease (IBD) that may affect any part of the gastrointestinal tract from mouth to anus / predispose to malignancy / It is a chronic transmural granulomatous inflammation

-Caused by a combination of environmental, immune and bacterial factors in genetically susceptible individuals

-Causes :

.autoimmune disease

.immunodeficiency

.irritable bowel syndrome

.Behçet's disease

-Symptoms :

.small bowel obstruction

.intestinal stenosis

.dysphagia

.inability to maintain growth in children

.lose appetite

.gallstones

.rheumatologic disease

.ankylosing spondylitis

.sacroiliac joint

.joints (arthritis)

.erythema nodosum

.pyoderma gangrenosum

.pulmonary embolism

.autoimmune hemolytic anemia

.vitamin B12, folate, iron deficiency

.seizures, stroke, myopathy, peripheral neuropathy, headache and depression

.diarrhoea,abdominal pain,weight loss

.clubbing

.fatty liver

.stones (only with CD)

*Ulcerative Colitis UC

-That causes inflammation and ulcers in the colon.It may affect just in the rectum

-Symptoms & Signs :

.rectum is involved in most cases

.diarrhoea,blood & mucos

.crampy abdominal discomfotr

.fever,malasia,anorexia,weight dec.,anemia (hearburn are NOT)

.clubbing

.erythema nodosum

.pyoderma gangrenosum

.conjunctivitis

.large joints erythritis

.sacrolitis

.ankylosing spondylitis

.fatty liver

.renal stones

.osteomalacia

.amyloidosis

.toxic megacolon may occur

.cholangitis

.arthropathy

-Systemic complications of ulcerative colitis include :

.Ankylosing spondylitis

.Sclerosing cholangitis

.Episcleritis

.Pericarditis

.pyoderma gangrenosum

.uveitis

.primary sclerosing cholangitis

+vitamin B12 deficiency(are NOT because at deudenum /only in CD)

-Investigations are beneficial in the diagnosis of ulcerative colitis :

.Stool studies

.Abdominal X-ray

.Colonoscopy

.Serologic studies (ANCA)

+Upper endpscopy (Are NOT)

+smoking (are NOT risk factor)

+Both are most accurately DIAGNOSED with endoscopy

+Both are TREATED with anti-inflammatory medications (mesalamine,azathioprine,6-mercaptopurine 6MP,steroides)

+Both forms of IBD can lead to colon cancer after 8-10 years of involvement of the colon

+Definite diagnosis of inflammatory bowel diseases by colonoscopic findings

Date: 2016-04-22; view: 597