Acute Perforation
A, Penetration of a gastric ulcer; B, Cross sectional view of stomach wall and pancreas
Hemorrhage
A, Endoscopic view; B, cross-section
A: H. pylori resident on the gastric epithelium; B: Electron micrograph
Pathogenesis
2. Hypersecretion of gastric acid
“No acid, no ulcer” now extends to “if acid, why ulcer”
Heartburn Belching Bloated feeling Nausea
Differential Diagnosis
Neoplasm of the stomach Pancreatitis Pancreatic cancer Diverticulitis Nonulcer dyspepsia (also called functional
3.Nonsteroidal Anti-inflammatory Drugs
4.Mucosal injury Mucus-bicarbonate layer
Surface epithelial cells Blood flow to mucosa
A: Balance is gotten between protective and hostile factors B: Balance is broken between protective and hostile factors
• Crow foot
crow foot
Vagal innervation of the stomach
L. Vagus
R. Vagus
Vagal innervation of the stomach
R.Vagus
Gastric Morphology
Gastric Cell Types, Location, and Fuction
Surgical indications for Peptic Ulcer
Four classic indications Intractability Hemorrhage Perforation & Penetration Obstruction
PART I Anatomy PART II Peptic Ulcer Disease PART III Neoplasms
Pathogenesis
1. Helicobacter pylori Infection
1. Production of toxic products to cause local tissue injury 2. Induction of a local mucosal immune response 3. Increased gastrin levels with a resultant increase in acid secretion
CELLS
LOCATION
Parietal Body
FUNCTION
Secretion of acid and intrinsic factor
Mucus Body, Antrum Mucus
Chief Body
Pepsin
G
Antrum
Gastrin
D
Body, antrum Somatostatin
Diseases of the Stomach and Duodenum
PART I Anatomy PART II Peptic Ulcer Disease PART III Neoplasms
Gross Anatomy: Divisions of the stomach
Blood supply to the stomach and duodenum
dyspepsia) Cholecystitis Gastritis
Complications of Peptic Ulcer
i) Perforation & Penetration—into pancreas, liver and retroperitoneal space
ii) Pyloric Obstruction iii) Hemorrhage
Gross Anatomy of the Duodenum
C Shaped
• Length: 12 fingers’ breadth
•
about 25 cm in adult
– D1 – D2 – D3
Superior part Descending part Horizontal part
– D4 Ascending part
Lymphatic drainage of the stomach
Nerve of the stomach
• Left vagus nerve – Anterior branches – Hepatic branches
• Right vagus nerve – Posterior branchction
Therapy
The clinician has three major goals when faced with a patient with ulcer disease:
1. Symptoms need to be relieved 2. The ulcer needs to be healed 3. Recurrence must be prevented
Clinical Presentation
Epigastric pain
Gastric ulcer Made worse by eating
Duodenal Ulcer Possibly worse at night Occurs 1-3 hours postprandial
Other symptoms