Rajasthan Vidyapeeth Homoeopathic

Medical College & Hospital, Dabok

Department of Surgery

Name- Anjum Abbasi

Standard- 3rd Year B.H.M.S.
Topic- Peptic Ulcer
Submitted to- Dr. Megha Chaudary
 Peptic Ulcer
• Introduction
• Pathophysiology
• Etiology
• Types of PUD (Peptic Ulcer Disease)
• Clinical Presentation
• Investigation Diagnostic Test
• Complications of PUD
• Management
• Homoeopathic Therapeutics
 Introduction
• Peptic ulcer is a lesion in the mucosal lining of
the digestive tract. Typically in the stomach or
duodenum, caused by the digestive action of
pepsin and stomach acid.
• Most of peptic ulcer occur either in the
duodenum or in the stomach.
• Ulcer may also occur in the lower oesophagus
due to reflexing of gastric content.
Pathophysiology
 Pathophysiology
• Under normal conditions, a physiologic balance
exists between gastric acid secretion and
gastroduodenal mucosal defense.
• Mucosal injury and, thus peptic ulcer occur when the
aggressive factors and the defensive mechanism are
disrupted.
• Aggresive factors such as NSAID’s, H. Pylori infection,
alcohol, bilesalts, acid and pepsin can alter he
mucosal defense by allowing back diffusion of
hydrogen ions and subsequent epithelial cell injury.
 Etiology / Risk Factors
• Lifestyle –
Smoking,
Acidic Drinks,
Medications.
• Gender – Duodenal are increasing in older women.
• H. Pylori infection – 90% have this bacterium. Passed from person (fecal-oral
route or oral-oral route)
• Age – Duodenal 30-40 yrs.
Gastric over 50 yrs.
• Genetic factors – More likely if family member has HX
• Other factors – Stress can worsen but not the cause.
Stress inducted ulceration after head trauma-Cushings ulcer.
Stress inducted ulceration after severe burns-Curlings ulcer.
 Types of PUD
• Gastric peptic ulcer – when sore is located in
the stomach.
• Duodenal peptic ulcer – when the sore is
located in he duodenum.
Duodenal ulcer
Gastric ulcer
Types of gastric ulcer
CLINICAL PRESENTATION
Clinical Presentation
 Investigation / Diagnostic test
• Stool examination for fecal occult blood.
• Complete blood count (CBC) for decrease in blood cells.
• Diagnostic test – Esophagogastrodeudonoscopy (EGD)
• Endoscopic procedure –
-Visualizes ulcer crater.
-Ability to take tissue biopsy to R/O cancer and diagnose H. Pylori.
• Upper Gastrointestinal series-
-Barium swallow
-X-ray that visualizes structure of the upper GI tract
• Urea Breath testing-
-Used to detect H. Pylori
-Client drinks a carbon-enriched urea solution
-Exhaled carbon-dioxide is then measured
• Alarming symptoms-
-Dysphagia
-Weight loss
-Vomiting
-Anorexia
-Hematemesis or Melena
Complication of peptic ulcer/gastric ulcer
• Haemorrhage- Blood vessels damaged as ulcer erodes
into the muscles of stomach or duodenum wall.
-Coffee ground vomitus or occult blood in tarry stools.
• Perforation- An ulcer can erode through the entire
wall.
-Bacterial and partially digested food spill into
peritoneum.
• Narrowing and obstruction- Swelling and scarring can
cause obstruction of food leaving stomach.
- Hour glass contracture: It occurs exclusively in
women, & it is due to cicatricial contracture of
lesser curve.
: Due to ulcer, stomach is divided into 2
compartments.
- Tea pot deformity: also known as hand bag
stomach
: It is due to cicatrisation & shortening of the
lesser curvature.
 Management
• Life style modification
• Hyposecretory drug therepy
-Proton pump inhibitions –> Suppress acid production.
->Prilosec,Prevacid.
-H2-Receptor Antagonists-> Block histamine- stimulated gastric
secretions.
-> Zantac, Pepcid, Axid.
-Antacids
->Neutralizes acid and prevents formation of pepsin.
->Eg. Maalox, Mylanta.
->Give 2 hours after meals and at bedtime.
-Prostaglandin analogs.
->Reduce gastric acid and enhances mucosal resistance to injury.
->Cytotec
-Mucosal barrier fortifiers
->Forms a protective coat
->Carafate / Sucralfate
->Cytoprotective

H. Pylori Eradication therapy

-Triple therepy
->Proton pump inhibition
-> Two antibiotics
1.Metronidazole+Clathromysin
2. Clathromysin +Anoxillation
-Surgical treatment
->indication-
>Failure of medical of medical treatment
>Development of complications
>Level of gastric secretion and combined
duodenal and gastric ulcer
-Principle of surgical procedure-Reduce acid and
pepsin secretion
 Types of surgical procedures
• Gastroenterostomy
-Creates a passage between the body and
stomach to small intestines.
-Allows regurgitation of alkaline duodenal
contents into thestomach.
-Keeps acid away from ulcerated area.
Gastroenterostomy
• Vagotomy
-Cuts vagus nerve
-Eliminates acid-secretion stimulus
• Pyloroplasty
-Widens he pylorus to guarantee stomach
emptying even without vagus nerve
stimulation.
• Antrectomy
-Lower half of stomach (antrum) makes most of
the acid.
Removing this prtion decrease acid production.
• Subtotal gastrectomy
-Removes 1/3 to 2/3 of stomach.
-Remained must be reattached to the rest of the bowel.
It is of two types-
1.Billroth I ->Distal portion of the stomach is removed .
->The remainder is anastomosed to the duodenum.
2.Billroth II –The lower portion of the stomach is
removed and the remainder is anastomosed to the
jejenum.
 Homoeopathic Therapeutics
• Argentum Nitricum - For abdominal bloating with belching and pain.
• Arsenium Album – For ulcers with intense burning pains and nausea,
especially for people who cannot bear the sight or smell of food and
are thirsty.
• Kali Bichromieum – For burning and shooting abdominal pain that is
worse in the hours after misnight.
• Lycopodium – For bloating after eating with burning that lasts for
hours ; especially for people who feel hungry soon after eating and
wakeup hungry.
• Nitric Acid – For sharp, shooting pain that worsens at night and is
accompanied by feeling of hopelessness and even fear of dying.
THANK YOU