Do you need to know about PUD?

Hamimsinfo
5 Jul, 2024

 PUD full form peptic ulcer disease. 

  •  What are the cause of upper abdominal  cause? 
  • Gall stone. 
  • Acute cholecystitis. 
  • Acute gastritis.
  • Acute duodenitis
  • perforated peptic ulcer. 
  • oesophagitis. 
  • Chronic peptic ulceratiin. 
  • carcinoma of the stomach.
  • splenomegaly.

 
Define of peptic ulcer disease. 

Peptic ulcer are the chronic, most often solitary lesion that occur the mucosal defect due to acid pepsin digestion of mucous membrane in any part of gastrointestinal track.
What are the common sites of peptic ulcer disease? 

  • First part of the duodenum.
  • Stomach. 
  • In the lower oesophagus.
  • Gastro jejunostomy stoma.
  • Meckels diverticulum.
What are the causes of peptic ulcer disease? 

  • infection : Helicobacter  pylori infection. 
  • Association : increase acid level.
  • Genetic &blood group O
  • Neurogenic :Anxiety &stress.
  • Endocrine: 
*Zolinger - Elilsion syndrome.
*Multiple adenoma syndrome. 
*Hyperparathyrodism.
  • Drug abuse :NSAID,Aspirin.
  • Accessory cause :-
*Smoking,delay healing &promote recurrence. 

*Alcohol. 
*Inadequate mastication.
*Irregular meal.
*Vitamin deficiency. 

What are the causative  oraganism and disabilities in the ulcerative process of peptic ulcer? 
Helicobacter pylori : Helicobacter pylori is a Gram negative, spiral bacillus and has multiple flagella at one end which make it motile, allowing it to burrow and live deep beneath the mucus layer closely adherent to the epithelial surface.

Mode of transmission :

  • Causative organism:Helicobacter  pylori.
  • Disabilities :pain is the most common.
  • Bleeding due to erosion of sub- mucosal or extra intestinal vessele.
  • Perfuration
  • Obstruction.

How do you diagnose &treat "Helicobacter pylori"?

  • Diseases   caused by Helicobacter  pylori :
  • Gastritis.
  • Duodenal ulcer.
  • Gastric ulcer. 
  • Gastric cancer.

Mechanism of disease  Process :

  • Secretes urease enzyme which breaks down urea and form toxin compound ammonium chloride and monochloramine. 
  • It enchance gastric acid secretion.
  • Impairs duodenal bicarbonate  production. 
  • causes epithelial injury and induction of inflammation. 
Investigation / tests for Helicobacter pylori:

  • 1.Non- invasive :
 *serology
*urea breath tests.
*Faceral antigen test.
Invasive (antral biopsy):*Histology
*Rapid urease test.  example: CLO &puloritek.
*Microbiological culture. 
Treatment or eradication 

  • 1st-line therapy (triple therapy) for 7days :
Omeprazole 20mg 12 hourly.
Bismuth 120mg 6 hourly. 
Amoxicillin 1gm 12 
hourly.
Matronidazole 400mg 6 hourly.

  • 2nd line therapy /quadruple therapy for 10-14days :
Omeprazole 20mg (12hourly).
Clarithromycin 500mg 12 hourly.
Metronidazole 400mg  8 hourly. 
Tetracycline 500mg 6 hourly.
Write down the clinical features and mention the diagnostic investigation of peptic ulcer disease. 

Management of peptic ulcer disease :

  • History :
  • age. Frequent  in middle age group. 
  • .sex :male to female ratio is 2:1.
  • Clinical features :
Symptoms :
  • Pain in the abdomen. 
  • Vomiting with or without blood mixed. 
  • Blood mixed stool may be present. 
  • Anorexia. 
  • weight loss or weight gain.
  • weakness.

Sings:
  • Anaemia may be present. 
  • Epigastric tenderness.
  • visible peristalis. 
  • In case of duodenal ulcer-pointing sign positive. 
  • In case of gastrc ulcer - pointing sign negative. 
  • Tachycardia.  
  • Temperature may be increased. 

Investigation :

  • Ultrasonography : To rule out other disease  and confirm Associated disease. 
  • Gastroduodenoscopy :
Investigation of choice.
Clearly reveal the site and character of ulcer in duodenum.
  • Stool :R/M/E.
  • Barium meal X-ray :
In case of gastric ulcer  to see niche and notch.
In case of duodenal ulcer shows deformed or absence of duodenal cap. 
  • Complete blood count (CBC).

Treatment :
  • General measures :

  • Bed rest:Reduce anxiety and feel comfortable. 
  • Nothing by mouth in acute condition, followed by normal regular diet.
  • parenteral nutrition in acute condition (intravenous fluid).
  • Avoid cigarette smoking. 
  • Agents which provide symptoms should be avoided e.g. Alcohol,NSAIDs,  corticosteroid. 

  • Medical treatment :
  • To relieve pain : Tab. Antacid 1tab. 8 hourly 30 min after meal.
  • To heal ulcer :
Ranitidine 150mg 1 tab. 12 hourly 30min before meal for 4-6weeks. Then 1 tab. At bed time for another 4-6weeks.
OR
Omeprazole 20mg  12hourly 30min before meal for in case of gastric ulcer for 8weeks and duodenal ulcer for 12 weeks. 

  • o relief anxiety and stress :
Diazepam 5 mg at bed time for 10days. 
  • Eradication of Helicobacter pylori:
Omeprazole 40mg or lansoprazole 30mg 12 hourly for 14days.
Metronidazole 400mg 12 hourly for 14 days. 
Amoxicillin  500mg 8 hourly for 14 days.

Surgical treatment :
  •  Billroth-II gastrectomy. 
  • Gastrojejunosty.
  • Truncal vagotomy and drainage.
  • Highly selective vagotomy. 
  • truncal vagotomy and antrectomy.
  • selective vagotomy with pyloroplasty. 

Complication of peptic ulcer disease :

  • Recurrent  ulceration. 
  • small stomach syndrome. 
  • Bile vomiting. 
  • Early and late dumping syndrome. 
  • post vagktomy diarrhoea. 
  • Maliganant transformation. 
  • Gall stone.  
  • Nutritional consequences. 
  • Haemorrhage.
  • Residual abscess.

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