A. DEFINITIONS
Peptic ulcer is a condition in which the unbroken continuity of the gastric mucosa and extends below the epithelium. Mucosal damage does not extend to the bottom of the epithelium is called erosion, although often considered as well as ulcers. (Eg, ulcers due to stress). Chronic peptic ulcer acute different premises, as it has scar tissue in the ulcer base. By definition, a peptic ulcer can be found in every part of the gastrointestinal tract are exposed to stomach acid resin, the esophagus, stomach, duodenum, and after gastroduodenal, also jejunum. Although the activity of peptic digestion by gastric lymph is an important etiological factor, there is evidence that this is only one factor of many factors that play a role in the pathogenesis of peptic ulcer.
B. ETIOLOGY AND INCIDENCE
Etiology of peptic ulcer is poorly understood, although gram-negative bacteria H. Pylori is believed to be a factor has been the cause. It is known that peptic ulcers occur only in the area of the GI tract is exposed to acid and pepsin hidrochlorida. The disease occurs with greatest frequency in individuals between the ages of 40 and 60 years. However, relatively rare in lactating women, although this has been observed in children and even infants. Famous men more often than women, but there is some evidence that the incidence in women is almost equal to men. After menopause, the incidence of peptic ulcer disease in women is almost equal to men. Peptic ulcer in the corpus gastric acid secretion can occur without excessivePredisposition:Efforts have been made to eliminate the ulcer personality. Some opinions say that stress or anger is not expressed predisposing factor. Ulcers seem to occur in people who tend to be emotional, but if this factor ballast condition, is still uncertain. The trend appears to be a family who also significant predisposing factor. Hereditary relations were later found in individuals with blood type is more susceptible than individuals with blood type A, B, or AB. Other predisposing factors are also associated with peptic ulcer include chronic use of nonsteroidal antiinflammatory drugs (NSAIDs). Excessive alcohol drinking and smoking. Recent studies indicate that gastric ulcers may be associated with bacterial infection with agents such as H. Pylori. The presence of these bacteria increased with age. Ulcer due to excessive amounts of hormone gastrin, which is produced by tumors (gastrinomas-Ellison syndrome-zolinger) are rare. Stress ulcer may occur in patients who are exposed to stressful conditions.
C. PATHOPHYSIOLOGY
Peptic ulcer is a condition in which the unbroken continuity of the gastric mucosa and extends below the epithelium. Mucosal damage does not extend to the bottom of the epithelium is called erosion, although often considered as well as ulcers. (Eg, ulcers due to stress). Chronic peptic ulcer acute different premises, as it has scar tissue in the ulcer base. By definition, a peptic ulcer can be found in every part of the gastrointestinal tract are exposed to stomach acid resin, the esophagus, stomach, duodenum, and after gastroduodenal, also jejunum. Although the activity of peptic digestion by gastric lymph is an important etiological factor, there is evidence that this is only one factor of many factors that play a role in the pathogenesis of peptic ulcer.
B. ETIOLOGY AND INCIDENCE
Etiology of peptic ulcer is poorly understood, although gram-negative bacteria H. Pylori is believed to be a factor has been the cause. It is known that peptic ulcers occur only in the area of the GI tract is exposed to acid and pepsin hidrochlorida. The disease occurs with greatest frequency in individuals between the ages of 40 and 60 years. However, relatively rare in lactating women, although this has been observed in children and even infants. Famous men more often than women, but there is some evidence that the incidence in women is almost equal to men. After menopause, the incidence of peptic ulcer disease in women is almost equal to men. Peptic ulcer in the corpus gastric acid secretion can occur without excessivePredisposition:Efforts have been made to eliminate the ulcer personality. Some opinions say that stress or anger is not expressed predisposing factor. Ulcers seem to occur in people who tend to be emotional, but if this factor ballast condition, is still uncertain. The trend appears to be a family who also significant predisposing factor. Hereditary relations were later found in individuals with blood type is more susceptible than individuals with blood type A, B, or AB. Other predisposing factors are also associated with peptic ulcer include chronic use of nonsteroidal antiinflammatory drugs (NSAIDs). Excessive alcohol drinking and smoking. Recent studies indicate that gastric ulcers may be associated with bacterial infection with agents such as H. Pylori. The presence of these bacteria increased with age. Ulcer due to excessive amounts of hormone gastrin, which is produced by tumors (gastrinomas-Ellison syndrome-zolinger) are rare. Stress ulcer may occur in patients who are exposed to stressful conditions.
C. PATHOPHYSIOLOGY
Peptic ulcers occur in the gastroduodenal mucosa because this tissue can not withstand stomach acid digestion work (hidrochlorida acid and pepsin). Erosion is associated with increased acid concentration and work peptin, or relating to reduction of the normal mucosal defense. Damaged mucosa can not secrete sufficient mucus acts as a barrier to hydrochloric acid.Gastric secretion occurs in three phases similar to:1.SefalikThe first phase began with stimuli such as sight, smell or taste of food that work on cerebral cortical receptors which in turn stimulates the vagal nerve. In essence, food that does not cause appetite caused little effect on gastric secretion. This is what caused the food often conventionally administered to patients with peptic ulcer. Today many experts agree that diet Gastroenterology strain has a significant effect on the acidity of the stomach or ulcer healing. However, excessive vagal activity during the night when stomach is empty is a significant irritant.
2.Fase gastricIn this phase of gastric acid released as a result of chemical and mechanical stimulation of the receptor than the stomach. Vagal reflex causes of acid secretion in response to gastric distension by food.3.Fase intestineFood in the small intestine causes the release of hormones (considered to be gastrin), which in time will stimulate gastric acid secretion.In humans, gastric secretion is a mixture of mukoprotein mukokolisakarida and continuously secreted by mucous glands. This mucus absorbs pepsin and protect the mucosa against acid. Hydrochloric acid is continuously secreted, but secretion increased due to the mechanism of neurogenic and hormonal stimuli that starts from the stomach and intestines. When hydrochloric acid is neutralized and dibuffer and not when the outer layer of the mucosa does not provide protection along with pepsin and hydrochloric acid will damage the stomach. Hydrochloric acid in contact only with a small surface of the hull. Then spread into it slowly. Mucosa that can not be entered into so-called gastric mucosal barrier. This is a defensive barrier against untama gastric digestion by gastric secretion itself. Another factor that affects the defense is the blood supply, acid-base balance, the integrity of the mucosal cells, and epithelial regeneration. Therefore, a person may have a peptic ulcer because of two factors: 1. hypersecretion of acid pepsin2. gastric mucosal barrier weaknessAnything that lowers the gastric mucosa or the gastric mucosal damage is ulserogenik, salicylates and other nonsteroidal antiinflammatory drugs, alcohol, and anti-inflammatory drugs fall into this category.Zollinger-Ellison syndrome (gastrinoma) is suspected when patients present with severe peptic ulcer or ulcer that does not heal with standard medical therapy. This syndrome is identified by the following findings: sap hypersecretion of the stomach, duodenal ulcer, and gastrinoma (tumor cells istel) in the pancreas. 90% of gastric tumors found in the triangle of the cyst and the duct koledokus, second and third part of duodenum, pancreas corpus and neck. Approximately ⅓ of the gastrinoma is malignant (malignant).Diarrhea and stiatore (unabsorbed fat in the stool) could be found. These patients can undergo parathyroid adenoma or hyperplasia koeksisten, and therefore may show signs of hypercalcemia. The patient's primary complaint was epigastric pain. Stress ulcer is the term given to the acute mucosal ulceration of the duodenal or stomach area that occurs after a physiologically stressful event. Stress conditions such as burns, shock, severe sepsis and multiple organ trauma with stress can cause ulcers. Fiberoptik endoscopy within 24 hours after injury showed superficial erosions in the stomach, after 72 hours, multiple gastric erosions seen. If the condition of stress ulcer continued spreading. If the patient is cured, the lesions on the contrary. This pattern is typical of stress ulceration.Another opinion is different from other causes of mucosal ulceration. Usually ulcerated mucosa by this shock caused a decrease gastric mucosal blood flow. Besides a large amount of pepsin is released. The combination of ischemia, acid and pepsin to create an ideal atmosphere to produce ulceration. Stress ulceration must be distinguished from Cushing's ulcer and ulcer curling, two other types of gastric ulcers. Cushing's ulcer is common in patients with brain trauma. These ulcers can occur in the esophagus, stomach, or duodenum, and are usually deeper and more penetrating than the stress ulcer. Curling ulcers often seen approximately 72 hours after extensive burns.
D. MANIFESTASI CLINICALUlcer symptoms can disappear for days, weeks, or months and may even disappear only to appear again, often without an identifiable cause. Many individuals have symptoms of ulcer, and 20-30% experienced a perforation or hemorrhage in the absence of a preceding manifestation.Pain: patients with ulcers usually complain of a dull pain, like a stabbing or burning sensation in the epigastrium or in the middle of the back. It is believed that the pain occurs when stomach acids and duodenum causing increased erosion and stimulate the nerve endings are exposed. Another theory suggests that contact with the acid lesions stimulate the local reflex mechanism mamulai surrounding smooth muscle contraction. Pain is usually relieved by eating, because eating to neutralize acid or with alkali, but when the stomach is empty or unused alkali back pain arises. Sharp local tenderness can be removed with gentle pressure on the epigastrium or slightly to the right of the midline. Some symptoms decreased by giving the local pressure on the epigastrium.Pirosis (pain uluhati): some patients experience a burning sensation in the esophagus and stomach, which rose to the mouth, sometimes accompanied eruktasi acid. Eruktasi or belching is common when a patient's stomach is empty.Vomiting: although rarely on duodenal ulcer was uncomplicated, vomiting can be symptoms of peptic ulcer. It is connected with the formation of scar tissue or acute swelling of the inflamed mucous membrane surrounding the acute ulcer. Vomiting may occur or without preceded by nausea, usually after being eliminated severe pain with the ejection of gastric acid content.Constipation and bleeding: constipation may occur in patients with ulcers, possibly as a result of diet and drugs. Patients may also come with a small portion of gastrointestinal bleeding due to ulcer patients who had not previously experienced acute complaints, but they show symptoms later.
E. DIAGNOSTICS EVALUATION
Physical examination may indicate the presence of pain, epigastric tenderness, or abdominal distention. Bowel sounds may not exist. With barium examination of the upper GI tract may indicate the presence of ulcers, but endoscopy is the diagnostic procedure of choice. Upper GI endoscopy is used to identify changes in inflammation, ulcers and lesions. Mucosa through an endoscope can be directly viewed and the biopsy obtained. Endoscopy has been shown to detect some lesions that are not visible through X-ray examination because of the size or location. Feces can be taken every day until the lab report is negative for occult blood. Gastric secretory examination is to determine the value in diagnosing aklorhidria (no gastric acid in the sap hdroklorida) and Zollinger-Ellison syndrome. Pain is relieved by food or antacids, and the absence of pain arising also identified the presence of ulcers. Presence of H. Pylory can be determined by biopsy and histology by culture, although this is a special laboratory tests. There are also tests that detect respiratory H. Pylori, as well as serological tests for antibody to the antigen H. Pylori.
F. TREATMENT
Several methods can be used to control stomach acidity, including lifestyle changes, medications, and surgery.Decrease stress and rest.Smoking cessationModification of dietDrugsSurgical intervention
2.Fase gastricIn this phase of gastric acid released as a result of chemical and mechanical stimulation of the receptor than the stomach. Vagal reflex causes of acid secretion in response to gastric distension by food.3.Fase intestineFood in the small intestine causes the release of hormones (considered to be gastrin), which in time will stimulate gastric acid secretion.In humans, gastric secretion is a mixture of mukoprotein mukokolisakarida and continuously secreted by mucous glands. This mucus absorbs pepsin and protect the mucosa against acid. Hydrochloric acid is continuously secreted, but secretion increased due to the mechanism of neurogenic and hormonal stimuli that starts from the stomach and intestines. When hydrochloric acid is neutralized and dibuffer and not when the outer layer of the mucosa does not provide protection along with pepsin and hydrochloric acid will damage the stomach. Hydrochloric acid in contact only with a small surface of the hull. Then spread into it slowly. Mucosa that can not be entered into so-called gastric mucosal barrier. This is a defensive barrier against untama gastric digestion by gastric secretion itself. Another factor that affects the defense is the blood supply, acid-base balance, the integrity of the mucosal cells, and epithelial regeneration. Therefore, a person may have a peptic ulcer because of two factors: 1. hypersecretion of acid pepsin2. gastric mucosal barrier weaknessAnything that lowers the gastric mucosa or the gastric mucosal damage is ulserogenik, salicylates and other nonsteroidal antiinflammatory drugs, alcohol, and anti-inflammatory drugs fall into this category.Zollinger-Ellison syndrome (gastrinoma) is suspected when patients present with severe peptic ulcer or ulcer that does not heal with standard medical therapy. This syndrome is identified by the following findings: sap hypersecretion of the stomach, duodenal ulcer, and gastrinoma (tumor cells istel) in the pancreas. 90% of gastric tumors found in the triangle of the cyst and the duct koledokus, second and third part of duodenum, pancreas corpus and neck. Approximately ⅓ of the gastrinoma is malignant (malignant).Diarrhea and stiatore (unabsorbed fat in the stool) could be found. These patients can undergo parathyroid adenoma or hyperplasia koeksisten, and therefore may show signs of hypercalcemia. The patient's primary complaint was epigastric pain. Stress ulcer is the term given to the acute mucosal ulceration of the duodenal or stomach area that occurs after a physiologically stressful event. Stress conditions such as burns, shock, severe sepsis and multiple organ trauma with stress can cause ulcers. Fiberoptik endoscopy within 24 hours after injury showed superficial erosions in the stomach, after 72 hours, multiple gastric erosions seen. If the condition of stress ulcer continued spreading. If the patient is cured, the lesions on the contrary. This pattern is typical of stress ulceration.Another opinion is different from other causes of mucosal ulceration. Usually ulcerated mucosa by this shock caused a decrease gastric mucosal blood flow. Besides a large amount of pepsin is released. The combination of ischemia, acid and pepsin to create an ideal atmosphere to produce ulceration. Stress ulceration must be distinguished from Cushing's ulcer and ulcer curling, two other types of gastric ulcers. Cushing's ulcer is common in patients with brain trauma. These ulcers can occur in the esophagus, stomach, or duodenum, and are usually deeper and more penetrating than the stress ulcer. Curling ulcers often seen approximately 72 hours after extensive burns.
D. MANIFESTASI CLINICALUlcer symptoms can disappear for days, weeks, or months and may even disappear only to appear again, often without an identifiable cause. Many individuals have symptoms of ulcer, and 20-30% experienced a perforation or hemorrhage in the absence of a preceding manifestation.Pain: patients with ulcers usually complain of a dull pain, like a stabbing or burning sensation in the epigastrium or in the middle of the back. It is believed that the pain occurs when stomach acids and duodenum causing increased erosion and stimulate the nerve endings are exposed. Another theory suggests that contact with the acid lesions stimulate the local reflex mechanism mamulai surrounding smooth muscle contraction. Pain is usually relieved by eating, because eating to neutralize acid or with alkali, but when the stomach is empty or unused alkali back pain arises. Sharp local tenderness can be removed with gentle pressure on the epigastrium or slightly to the right of the midline. Some symptoms decreased by giving the local pressure on the epigastrium.Pirosis (pain uluhati): some patients experience a burning sensation in the esophagus and stomach, which rose to the mouth, sometimes accompanied eruktasi acid. Eruktasi or belching is common when a patient's stomach is empty.Vomiting: although rarely on duodenal ulcer was uncomplicated, vomiting can be symptoms of peptic ulcer. It is connected with the formation of scar tissue or acute swelling of the inflamed mucous membrane surrounding the acute ulcer. Vomiting may occur or without preceded by nausea, usually after being eliminated severe pain with the ejection of gastric acid content.Constipation and bleeding: constipation may occur in patients with ulcers, possibly as a result of diet and drugs. Patients may also come with a small portion of gastrointestinal bleeding due to ulcer patients who had not previously experienced acute complaints, but they show symptoms later.
E. DIAGNOSTICS EVALUATION
Physical examination may indicate the presence of pain, epigastric tenderness, or abdominal distention. Bowel sounds may not exist. With barium examination of the upper GI tract may indicate the presence of ulcers, but endoscopy is the diagnostic procedure of choice. Upper GI endoscopy is used to identify changes in inflammation, ulcers and lesions. Mucosa through an endoscope can be directly viewed and the biopsy obtained. Endoscopy has been shown to detect some lesions that are not visible through X-ray examination because of the size or location. Feces can be taken every day until the lab report is negative for occult blood. Gastric secretory examination is to determine the value in diagnosing aklorhidria (no gastric acid in the sap hdroklorida) and Zollinger-Ellison syndrome. Pain is relieved by food or antacids, and the absence of pain arising also identified the presence of ulcers. Presence of H. Pylory can be determined by biopsy and histology by culture, although this is a special laboratory tests. There are also tests that detect respiratory H. Pylori, as well as serological tests for antibody to the antigen H. Pylori.
F. TREATMENT
Several methods can be used to control stomach acidity, including lifestyle changes, medications, and surgery.Decrease stress and rest.Smoking cessationModification of dietDrugsSurgical intervention
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