ACID PEPTIC DISEASE

Presented by
K. Kavya Sri
256217882011
MRCP
 DEFINITION
• Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper
portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain.
• Peptic ulcers include:
• Gastric ulcers that occur on the inside of the stomach
• Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum)
 EPIDEMIOLOGY
• In the United States, peptic ulcer disease affects approximately 4.6 million people annually, with
an estimated 10% of the US population having evidence of a duodenal ulcer at some time.
• H pylori infection accounts for 90% of duodenal ulcers and 70-90% of gastric ulcers.
• In a systematic review of 31 published studies, the pooled incidence of uncomplicated peptic ulcer
disease (PUD) was approximately one case per 1000 person-years in the general population, and
the incidence of ulcer complications was approximately 0.7 cases per 1000 person-years 
 ETIOLOGY
• Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach or small
intestine. The acid can create a painful open sore that may bleed.
• Your digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of
acid is increased or the amount of mucus is decreased, you could develop an ulcer.
• A bacterium. Helicobacter pylori bacteria commonly live in the mucous layer that covers and protects tissues
that line the stomach and small intestine. Often, the H. pylori bacterium causes no problems, but it can cause
inflammation of the stomach's inner layer, producing an ulcer.
• Regular use of certain pain relievers. Taking aspirin, as well as certain over-the-counter and prescription
pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs) , can irritate or inflame the lining of
your stomach and small intestine. These medications include ibuprofen, naproxen sodium, ketoprofen and
others. They do not include acetaminophen.
• Other medications: other medications include steroids, anti coagulants, low dose aspirin, SSRIs, etc.
 RISK FACTORS
• Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
• Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases
the amount of stomach acid that's produced.
• Have untreated stress.
• Eat spicy foods.
• Alone, these factors do not cause ulcers, but they can make ulcers worse and more difficult to heal.
• Other conditions include trauma, burns, stress, etc.
 COMPLICATIONS
• Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood
loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or
bloody vomit or black or bloody stools.
• A hole (perforation) in your stomach wall. Peptic ulcers can eat a hole through (perforate) the
wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal
cavity (peritonitis).
• Obstruction. Peptic ulcers can block passage of food through the digestive tract, causing you to
become full easily, to vomit and to lose weight either through swelling from inflammation or
through scarring.
• Gastric cancer. Studies have shown that people infected with H. pylori have an increased risk of
gastric cancer.
PATHOPHYSIOLOGY
 SIGNS AND SYMPTOMS
• Burning stomach pain
• Feeling of fullness, bloating or belching
• Intolerance to fatty foods
• Heartburn
• Nausea
• The most common peptic ulcer symptom is burning stomach pain. Stomach acid makes the pain worse, as does
having an empty stomach. The pain can often be relieved by eating certain foods that buffer stomach acid or by
taking an acid-reducing medication, but then it may come back. The pain may be worse between meals and at night.
• Many people with peptic ulcers don't even have symptoms.
• Vomiting or vomiting blood — which may appear red or black
• Dark blood in stools, or stools that are black or tarry
• Trouble breathing
• Unexplained weight loss
 DIAGNOSIS
• Blood tests
• Breath test
• Stool test
• For the breath test, you drink or eat something that contains radioactive carbon. H. pylori breaks
down the substance in your stomach. Later, you blow into a bag, which is then sealed. If you're
infected with H. pylori, your breath sample will contain the radioactive carbon in the form of
carbon dioxide.
• Endoscopy
• X-rays
 MANAGEMENT
• Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your doctor may recommend a
combination of antibiotics to kill the bacterium. These may include amoxicillin (Amoxil), clarithromycin (Biaxin),
metronidazole (Flagyl), tinidazole (Tindamax), tetracycline and levofloxacin.
• Medications that block acid production and promote healing. Proton pump inhibitors — also called PPIs — reduce
stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and
over-the-counter medications omeprazole, lansoprazole, rabeprazole, esomeprazole and pantoprazole.
• Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount
of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing.
• Available by prescription or over the counter, acid blockers include the medications famotidine, cimetidine and
nizatidine.
• Antacids that neutralize stomach acid
• Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe
medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine.
• Options include the prescription medications sucralfate and misoprostol.
CASE PRESENTATION
 SUBJECTIVE DATA
• A 18 year old male patient admitted into the hospital with the following complaints:
• c/o burning in epigastric region since 2 days.
• Similar complaints in the past, before 3 months after the alcohol intake.
• The patient consumes alcohol regularly.
 VITALS
DAYS DAY-1 DAY-2 DAY-3 DAY-4

TEMPERATURE N N N N

BLOOD PRESSURE 130/90 125/80 125/80 130/90

PULSE RATE 86 89 95 91
 COMPLETE BLOOD PICTURE

PARAMETERS OBSERVED VALUE NORMAL RANGE

Hb 14.2 11-16
RBC 4.9 4-6.5
WBC 8100 4000-11000
NEUTROPHILS 70% 40-70%
LYMPHOCYTES 20% 20-45%
EOSINOPHILS 2% 1-6%
PLATELET COUNT 3.0 1.5-4.5
 SERUM ELECTROLYTES

PARAMETERS OBSERVED VALUE NORMAL RANGE

SERUM SODIUM 141 135-156

SERUM POTASSIUM 3.6 3.6-5.5

SERUM CHLORIDES 102 98-108

 ASSESSMENT
• From the above subjective and objective data it is confirmed that the patient wa
diagnosed with acid peptic disease.
 TREATMENT PLAN
TRADE NAME GENERIC ROUTE DOSE FREQU D-1 D-2 D-3 D-4
NAME ENCY

Inj. PAN Pantoprazole IV 40mg BD    

Syp. SUCRALFATE Sucralfate P/O 10ml TID    

Inj. TRAMADOL Tramadol IV 1amp SOS    

Inj. BUSCOPAN Hyoscine IV 1amp Stat    

butylebromide

Syp. MUCAINE Aluminium P/O 5ml TID    

GEL hydroxide &
magnesium
hydroxide
 PATIENT COUNSELLING
• Limit alcohol consumption.
• Better to avoid the intake of alcohol
• Regular exercise.
• Maintain a healthy diet
• Avoid NSAIDS and foods that trigger acid production or heart burn.
THANKYOU