Monday, February 6, 2012

Comparing Duodenal and Gastric Ulcers

In this post, you can see the dissimilarity of the two diseases in 4 categories such as 1. incidence, 2. signs and symptoms and clinical findings, 3. malignancy possibility, 4. risk factors.

To begin with the incidence, Duodenal ulcer occurs mostly at the age of 30-60 yrs old with a male:female ratio of 2-3:1 and some research shows that 80% of the peptic ulcers are duodenal while the Gastric ulcer usually occurs 50 yrs old and above with a male:female ratio of 1:1 and 15% of peptic ulcers are gastric.

In the category number 2 which is the signs, symptoms and the clinical findings, Duodenal ulcer occurs because of the hypersecretion of the stomach acid and may have a clinical manifestation of gaining weight. Moreover, pain occurs 2-3 hours after a meal, often awakened between 1-2AM and ingestion of food relives pain and thus gaining weight occurs. While the Gastric ulcer occurs due to normal to hyposecretion of stomach acid and weight loss may occur. In addition, pain occurs 1/2 to 1 hour after a meal, rarely occurs at night. It maybe relieve by vomiting and ingestion of food does not help and sometimes it increases pain.

Going to category 3 about the malignancy factors, Duodenal ulcer rarely become a factor to malignancy or cancer. On the other hand, Gastric ulcer occasionally part of malignancy factors that causes cancer.

Finally the category of risk factors, Duodenal ulcer can be triggered by the following risk factors like H.pylori, blood group O, chronic obstructive pulmonary disease (COPD), chronic renal failure, alcohol intake, smoking, liver cirrhosis and stress. However, Gastric ulcer has few risk factors compared to duodenal this are H.pylori, gastritis, alcohol intake, smoking, taking non steroidal anti-inflammatory drugs (NSAID's) and stress.

Want to know about Peptic ulcer disease?

Wednesday, December 7, 2011

Gatrointestinal disorder - promotion and prevention

Today, one of my friend in facebook posted that he is hurt because of stomach ulcer and I want to help him by this post.

In promoting home and community based care, health care professional will teach the community how to do self care. The knowledge of the people or community about gastritis is evaluated and an individualized teaching plan is developed that includes information about stress management, diet and medication. Dietary instructions take into account the patients daily caloric needs, food preferences and pattern of eating. Foods ans other substances to be avoided example spicy, irritating or highly seasoned foods; caffeine; nicotine; alcohol are reviewed. Consultation with a nutritionist may be indicated.

Providing information about prescribed antibiotics , bismuth salts , medications to decrease gastric secretion  that might cause stomach ulcer, and medications to protect mucosal cells from gastric secretions can help the patient recover and prevent recurrence. People with pernicious anemia need information about long term vitamin b12 injections; a family member may be instructed in the administration of these injections or arrangements can be made for the patient to receive the injections from a health care provider.

Wednesday, November 23, 2011

Peptic Ulcer Disease, who are you?

Let me start with asking a question what is peptic ulcer? what is the cause of it? how it progresses? what are the things need to be considered? This questions are necessary in finding the facts about this specific disease. I hope that this will help in knowing PUD and understanding it so that it will be prevented. Education is the best prevention.

A peptic ulcer is an excavation (hollowed-out area) formed in the mucosal wall of the stomach, the pylorus (opening between stomach and duodenum ), the duodenum (first part of the small intestine), or the esophagus. A peptic ulcer is frequently referred as to gastric, duodenal, or esophageal ulcer depending on its location, or as peptic ulcer disease. It is caused by the erosion of a circumscribed area of mucous membrane. This erosion may extend as deeply as the muscle layers or through the muscle to the peritoneum. Peptic ulcers are more likely to be in the duodenum than in the stomach. As a rule they occur alone, but they may occur in multiples. Chronic gastric ulcers tend to occur in the lesser curvature of the stomach, near the pylorus.

Zollinger-Ellsion syndrome (ZES), which consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin secreting benign or malignant tumors of the pancreas, is a type of peptic ulceration. Stress ulcers, which are clinically different from peptic ulcers, are ulceration in mucosa that can occur in the gastroduodenal area. Both of these conditions are discussed with peptic ulcers.

The gram negative bacteria H. pylori is present in 70% of patients with gastric ulcers and 95% of patients with duodenal ulcer. It is not associated with esophageal ulcers. Peptic ulcers treated with antibiotics to  eradicate H. pylori that causes ulcer, have a 10% recurrence rate; those not treated for H. pylori have a 95% recurrence rate. The disease occurs with the greatest frequency in people between ages  of 40 to 60 years. It is relatively uncommon in women of childbearing age,but it has been observed in children and even infants.

In the past, stress and anxiety were thought to be the causative factors in ulcer occurrence. Ulcers do seem develop more commonly in people who are tense, but whether this is a contributing factor to the condition is uncertain. The presence of the excessive secretion of hydrochloric acid in the stomach may contribute to the formation of gastric ulcers, and stress may be associated with an increase in hydrocloric acid secretion. The ingestion of milk and caffeinated beverages, smoking and the alcohol may also increase hydrochloric acid secretion.

Tuesday, November 22, 2011

Surgical Procedures for Peptic Ulcer Disease

Here are the list of some surgical procedure that are very effective and advisable to those patient with PUD that are candidate for surgery. Before that you're doctors knows best as to what is the right surgical procedure needs to be done. Let me start with vagotomy, truncal vagotomy, selective vagotomy, pyloroplasty, antrectomy and anastomosis.

Vagotomy - severing of the vagus  nerve, which decreases gastric acid by diminishing cholenergic stimulation to the parietal cells, making them less responsive to gastrin. May beperformed to reduce gastric acid(cause of ulcer) secretion. A drainage type of procedure is usually performed to assist with gastric emptying as there is total denervation of the stomach. Some patients have problems with feelings of fullness, dumping syndrome, diarrhea and gastritis.

Truncal vagotomy - severing of the right and left vagus nerves as they enter the stomach at the distal part of the esophagus. This type of vagotomy is most commonly used to decrease acid secretions and reduce gastric and intestinal motility. Recurrence rate is 10% - 15%.

Selective vagotomy - severing of vagal innervation to the stomach but maintains innervation to the gastric antrum and pylorus. There is no dumping syndrome and no need for drainage procedure. The recurrence rate is 10% - 15%.

Pyloroplasty - a surgical procedure in which a longitudinal incision is made into the pylorus and transversely sutured closed to enlarge the outlet and relax the muscle. Usually accompanies truncal and selective vagotomies, which produce delayed gastric emptying due to decreased innervation.

Antrectomy ( Billroth I -gastroduodenostomy, Bilroth II - gastrojejunostomy ) - removal of the lower portion of the antral portion of the stomach which contains the cells that secrete gastrins as well as small portion of the duodenum and pylorus. The remaining segment is anastamosed to the duodenum ( Billroth I ) or jujenum ( Billroth II ). May be performed in conjuction with a truncal vagotomy. The patient may have problems with feeling of fullness, dumping syndrome and diarrhea. The recurrence rate is <1%.

Subtotal gastrectomy with Billroth I or II anastomosis - removal of distal third stomach; anastomosis with duodenum or jejunum. Removes gastrin- producing cells in the antrum and part of the parietal cells. Dumping syndrome, anemia, malabsorption, weight loss may happen but the recurrence rate is 10% - 15%.

Drug Therapy for Peptic Ulcer Diseases II

This the continuation of my other post, that tackles the proton pump inhibitor with the main action is to decrease the gastric acid secretion thus helps in reducing ulcer progress. The other one is the cytoprotective medications with the primary action is to protect the mucosal lining thus eliminates gastric irritation.

Proton (Gastric Acid) Pump Inhibitor

Omeprazole ( Prilosec ) - decreases gastric acid secretion by slowing the hydrogen-potassium-adenosine triphosphate (H+,K+-ATPase) pump on the surface of the parietal cells. The patient should be infromed the long term use may cause ulcer or gastric tumors and bacterial invasion so that they are aware of this.

Cytoprotective Medications

Misoprostol( Cytotec ) - a synthetic prostaglandin, protects the gastric mucosa from ulcerogenic agents. It increases mucus production and bicarbonate levels to reduce acidity that may cause ulcer progresses. It is also used as preventive method inpatients using NSAIDs. It is advisable to take the drug with food to reduce gastrointestinal irritation. The patient should be inform about the side effects such as that might cause diarrhea and cramping  include uterine cramping. Not advisable to take during pregnancy and please tell your doctor so abortion may prevented.

Sucrafate ( Carafate ) - in the presence of gastric acid, sucralfate creates a viscous protective substance, forming a protective layer at the site of the ulcer, and prevents digestion by pepsin. May cause constipation or nausea so the patient should be inform. Approved to use it  for duodenal ulcers as a drug of choice, not  in gastric ulcers.

Histamine (H2) Receptor Antagonists for Peptic Uclers

This are the drug of choice PUD. My last post was all about the drug therapy with its primary concern was Antibiotics and Bismuth salts. And now let us know the other drug classification that helps in treating PUD. The another class is the Histamine (H2) Receptor Antagonists and its primary action is to block the H2 receptor.

Cimetidine ( Tagamet ) - inhibits acid ( cause of ulcer ) secretion by blocking the action of histamine on the histamine receptors of the parietal cell in the stomach. This drug is the least expensive of the H2 receptor antagonists thus it more affordable to the public. Because it is least expensive their must be a bigger side effects compared to other drugs. The patient should be warn the this may cause confusion, agitation or coma in the elderly. To those with renal  or hepatic insufficiency, it is advisable to tell the doctor about this so that they will be aware of the situation and change their drug of choice. Long term use may cause gynecomastia or enlarged breast in male, impotence to both sexes and diarrhea. The patient should be inform about this matter.

Ranitidine ( Zantac ) - inhibits acid secretion by blocking the action of histamine on the histamine receptors of the parietal cell in the stomach. It has prolonged drug half-life in patients with renal and hepatic insufficiency. Causes fewer side effects than cimetidine. It is rarely causes constipation, diarrhea, dizziness and depression

Famotidine ( Pepcid ) - inhibits acid secretion by blocking the action of histamine on the histamine receptors of the parietal cell in the stomach. Best choice for critically ill patients because it is known to have least risk of interaction with drugs other than cimetidine. It is unclear if other H2 receptor antagonists are as safe as famotodine. It does not alter drug metabolism in the liver. It has prolonged drug half-life in patients with renal and hepatic insufficiency. It can be use for short term relief for gasttroesophageal reflux or heart burn. The good thing is it rarely causes constipation or diarrhea.

Nizantidine ( Axid ) -inhibits acid secretion by blocking the action of histamine on the histamine receptors of the parietal cell in the stomach. Most doctors usually used it for duodenal ulcers as a drug of choice. It has prolonged drug half-life in patients with renal and hepatic insufficiency. Another good thing is it rarely causes sweating , increased liver enzymes, nausea and urticaria (skin irritation).

Drug Therapy for Peptic Ulcer Diseases

Here are the list for the drug of choice with regards in treating peptic ulcer disease. I have mention before about the PUD in cancer patient as one of the complication might arise with patient ongoing on Chemotherapy.So, know its time to know the drugs that helps in aiding and healing peptic ulcer disease. First is the Antibiotics and Salts.

Antibiotics and Bismuth Salts

Tetracycline(plus metronidazole and bismuth salts) - exerts bacteriostatic effects to eradicate H.pylori bacteria, as one of the cause of ulcer  in the gastric mucosa. This drug may cause photosensitivity reaction so tell the patient to use sunscreen or eye glasses when going outside on a sunny day. Use with caution in patients with renal or hepatic impairment because it may harm our kidney and liver. When taken with milk or dairy products, medication effectiveness may be reduced thus it is advisable not take dairy products or milk during the medication.

Amoxicillin (plus metronidazole and bismuth salts or with high dose of proton pump inhibitor) - a bactericidal antibiotic that assists with eradicating H.pylori bacteria( causes ulcer) in the gastric mucosa. May cause diarrhea as an effects and patient should be oriented about this so that he or she will recognized it is the side effect of the drug. Do a health history by asking the patient if he or she allergic to penicillin. If she is allergic then don't give the frug

Metronidazole (Flagyl) - an amebicide that assists with eradicating H.pylori bacteria in the gastric mucosa. It is recommended to give meals before taking the drug to decrease gastrointestinal distress as one of the side effects.

Clarithromycin (Biaxin) (use with proton pump inhibitor or H2 receptor antagonist) - exerts bacterial effects to         eradicate H. pylori bacteria in gastric mucosa. Educate the patient that this drug may cause gastrointestinal upset.

Bismuth subsalicylate (Pepto-Bismol) (use with antibiotics) - supresses H.pylori bacteria in the gastric mucosa and helps mucosal lesions heal. this is given concurrently with antibiotics to cure H. pylori infection.