What is peptic ulcer disaese and what are preventive measures.

Peptic ulcers-

Peptic ulcers form In the upper Gastrointestinal tract that affect lining of stomach (gastric ulcers), duedenum which is part of small intestine (duedenal ulcers) and also in lower part of oesophagus.

Causes-

1. H.pylori (helicobacter pylori) it is most common cause of peptic ulcer.

2. Non steroidal anti-infalamatory drugs.(NSAIDS)

3. Mental stress.

4. Smoking.

5. Alcohol consumption.

6. Genetics.

How they form? (Pathophysiology)-

In our stomach there is mucosa layer which play important role in protection of stomach from erosion.

Mucosa-

This is layer which release mucous rich in bicarbonate and help to protect lining from acid secreted by parietal cells of stomach.

Different cells function-

1. Parietal cells release HCL acid which is helpful in digestion of food but due to its acidic nature it tend to erode mucosal line when there is low bicarbonate secretion by mucosa.

2. Chief cells release pepsinogen which mix with HCL and form pepsin.

3. G- cells release gastrin.

Prostaglandins-

These have major role in regulating perfusion in stomach which leads to good work of cells. It also regulate mucus to release bicarbonate and also control acid production from parietal cells.

This all systems of normal functions get disturbed due to all causative agents by following process- 

1. H.pylori which is most common bacteria cause erosion of lining of stomach 

When cell get damage  leads to release of histamine which give signal to parietal cells to produce more HCL and which erode stomach lining.

H.pylori is spiral shape bacteria which help it to easily enter into mucosa.

How H.pylori survive in acidic nature of stomach-

H.pylori produces urease and  breakdown to urea which produces Amonia that's why patient with peptic ulcers have amonic smell in their breath. This amoniA neutrilize acid and erode lining. This bacteria spread through contaminated water and feco-oral route.

2. NSAIDS-  these included Ibuprofen, Aspirin , Indomethacin. These drugs lead to decrease production of prostaglandins and before we studied functions of prostaglandins. These functions get disturbed and leads to erosion of lining.

Another cause also lead same process of erosion.

What sign and symptoms patient have -

Commonly sign and symptoms in this includes 

* Indigestion.

* Epigastric pain.

* Pain will be dull or aching.

* Epigastric pain.

 But there is difference between the gastric and duedenum ulcers sign and symptoms that is-

In gastric ulcers-

1. Food makes pain worst because when we take food it's enter firstly in stomach and HCL starts release which make pain worse within half an hour after ingestion of food.

2. Patient not complain pain at night.

3. Pain is dull and aching.

4. Weight loss. Because patient will be unable to take proper diet due to pain.

5. Severe vomiting with coffee , ground or bright red blood.

Duodenal ulcers-

1. Food make pain better. But pain get after 3-4 hrs after taking meal because food get into intestine after 3-4 hrs.

2. Patient complaint pain at night.

3. Pain is Inawing.

4. Weight is normal.

5. Dark colour stool due to blood present in stool.( Melena).

Diagnosis-

1. Endoscopy

2. Barium swallow.

3. CT scan.

4. Blood and stool test for H.pylori.

If H.pylori present than there will be smell of Amonia in breath.so breath test should done also carbon dioxide measurement done because urea break into Amonia and Carbon dioxide.

Complications-

1. GI bleeding.

2. Bowel blockage due to chronic obstruction.

3. Increase risk of GI cancer.

Treatment-

Medications-

* Proton pump inhibitors.

* Histamine receptor blocker.

* Antibiotics.

* Antacids.

In severe cases patient require surgery included-

1 . Vagactomy - Removal of vagus Nerve.

2. Pyloroplasty- surgery performed to widened lower part of stomach called pylorus.

3. Total gastrectomy- removal of stomach and anastomosis of oesophagus with intestine. After this it's important to look for dumping syndrome which is characterized by the emptying of  food directly into intestine in bulk and cause many complications like sudden increase in sugar etc.

Education to patient-

1. Eat small and frequent food.

2. Do not drink fluid with food.

3. Avoid sugary food and drinks.

4. Avoid very hot and cold food.

5. Take high protein , high fibers and low carb food.

6. Avoid spicy food , coffee, alcohol and fried foods.

7. Encourage to consume  food easily digestible eg. Rice and banana.