Acute Peptic Ulcer (Gastric or Duodenal Ulcer) : Definition, Etiology, Types, Pathophysiology, Signs, Symptoms, Complications, Diagnosis, Management, Diet, & Prevention
Definition
- Peptic ulcers are usually the areas of degeneration, multiple erosions and necrosis of gastrointestinal mucosa due to disruption of the mucosal barrier or increased acid-peptic secretions.
Gastric Ulcer v/s Duodenal Ulcer
| Features | Gastric (Stomach) Ulcer | Duodenal Ulcer |
| Etiology | ↓ mucosal resistence | ↑ acid production |
| H. pylori association | 75% | 90% |
| Pain | Continuous, Increases on taking meal, More in lean & thin | Seasonal, Increases with hunger, Decreases on taking meal, More in obese |
| Complications | Perforations (most common), Bleeding (left gastric artery) | Bleeding (most common)(bleeding artery: gastroduodenal artery) |
| Haematemesis : Malaena | 60:40 | 40:60 |
| Cancer | Found | Rare |
| Weight | Weight loss | Weight gain |
| Treatment | Gastrectomy | Vagotomy & Drainage |
1. Gastric Ulcer
Classification
Daintree Johnson Classification
| Type | Location | Incidence | Acid level |
| Type I | In the antrum, near the lesser curve | 55% | Normal |
| Type II | Combined gastric ulcer (in the body) with duodenal ulcer | 25% | High |
| Type III | Prepyloric ulcer | 15% | High |
| Type IV | Gastric ulcer in the proximal stomach or cardia | 5% | Normal |
| Type V | Diffuse ulcer (due to NSAIDs) |
Complications
1. Hourglass stomach
- It occurs exclusively in women, is due to cicatricial contracture of lesser curve ulcer.
- Here stomach is divided into two compartments.
Clinical features
- Loss of periodicity
- Persistent pain
- Vomiting
- Loss of appetite and weight
Diagnosis
- Barium meal: It shows filling only in the proximal stomach or double pouched stomach.
- Gastroscopy.
Treatment
- Partial gastrectomy wherein gastric ulcer with lower compartment of the stomach is removed and Billroth-I anastomosis is done.
2. Tea-pot stomach (Hand-Bag stomach)
- It is due to cicatrisation and shortening of the lesser curvature.
- They present with features of pyloric stenosis.
- Treatment is partial gastrectomy with Billroth-I anastomosis.
3. Perforation
4. Bleeding
- Bleeding artery: Left gastric artery
5. Gastric outlet obstruction
6. Penetration
- Posteriorly into pancreas, anteriorly into liver.
7. Malignancy
Treatment
A. Medical
B. Surgical
- Gastrectomy + Billroth anastomosis
Preferred are
- Partial gastrectomy + Billroth I : For gastric ulcer
- Gastrectomy + Billroth II : For distal gastric ulcer, duodenal ulcer
- Gastrectomy + Polya
2. Duodenal Ulcer
Treatment
A. General measures
B. Medical
C. Surgical
- Vagotomy + Drainage
Vagotomy
- Highly selective vagotomy (HSV) : No drainage required.
- Selective vagotomy
- Truncal vagotomy
Drainage
- Pyloroplasty
- Gastrojejunostomy
Preferred are
- Highly selective vagotomy (HSV)
- Selective vagotomy with Pyloroplasty
- Truncal vagotomy with Gastrojejunostomy
- Truncal vagotomy with Antrectomy (Recurrence < 1% but not preferred nowadays)
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