Peptic ulcer disease symptoms, diagnosis and treatment. In patients with peptic ulcer disease, most ulcers will not be visible on ct since they affect the superficial layers of gastric or duodenal wall. Diagnosis and treatment of perforated peptic ulcer dr. Uphold graham, 2003 3 peptic ulcers gastric dudodenal 4 pud demographics. Direct repair of the perforation with pedicled omentum gave. Epidemiology of peptic ulcer disease and its complications complications to peptic ulcer disease include perforation, bleeding, and obstruction. Pain that awakes the patient from sleep between midnight and 3 a. Pain between the breastbone and the navel may occur when the stomach is. However, this relationship between infection and perforation can be established upon undertaking further studies. Although helicobacter pylori and use of nonsteroidal antiinflammatory drugs are common causes, demographic.
Although pud is most commonly caused by helicobacter pylori infection or use of nonsteroidal anti. The most common symptom of a peptic ulcer is burning abdominal pain that extends from the navel to the chest, which can range from mild to severe. Pdf surgical management of perforated peptic ulcer disease. Pdf surgery for perforated peptic ulcer disease is one of the most common emergency procedures carried out in the western world. Perforated peptic ulcer ppu occurs in less than 15% of cases but is associated with significant morbidity and mortality rates. Perforated peptic ulcer, with associated peritonitis and sepsisseptic shock, is a medicalsurgical emergency requiring rapid evaluation and management. Pdf background the incidence of perforated peptic ulcer is approximately 7 10 cases per one lakh population per year. Ultrasound is less sensitive for detecting free air but could be used to identify other indirect findings of perforation such as free fluid and decreased peristalsis when the diagnosis. If pneumoperitoneum is identified on plain radiographs, there is no need for further studies. Peptic ulcers usually present as chronic, upper abdominal pain related to eating a meal dyspepsia.
Among current users of oral glucocorticoids in combination with other ulcer related drugs the mortality ratio was 1. Complications are encountered in 10%20% of these patients and 2%14% of the ulcers will perforate 2, 3. Patients with perforated peptic ulcer disease usually present with a sudden onset of severe, sharp abdominal pain. Approximately 500,000 new cases are reported each year, with 5 million people affected in the united states alone. The predominant causes in the united states are infection with helicobacter pylori and use of nonsteroidal anti.
Ulcers located near the esophagogastric junction require subtotal gastrectomy with a rouxeny esophagogastrojejunostomy csendes procedure. Protocol for diagnosis and treatment of peptic ulcer in adults. Peptic ulcer is a hole or open sore in the lining of the stomach, duodenum beginning of the small intestine or oesophagus. Di saverio md introduction every year peptic ulcer disease pud affects 4 milion people around the world 1. Role of culture in cases of perforated peptic ulcers due.
The presentation of patients with marginal ulcer perforation should. Peptic ulcer disease usually occurs in the stomach and proximal duodenum. Every year peptic ulcer disease pud affects 4 milion people around the world. Peptic ulcer disease is common with a lifetime prevalence in the general population of 510% and an incidence of 0. Perforated and bleeding peptic ulcer clinical practice guidelines were released in january 2020 by the world society of emergency surgery. Surgery for perforated peptic ulcer disease is one of the most common emergency procedures carried out in the western world. Severe, suddenonset epigastric pain or generalized pain might. Eradication of hp infection alters the natural history of peptic ulcer disease. Review open access diagnosis and treatment of perforated or. Mar 25, 2020 the global incidence and prevalence of peptic ulcer disease, along with the associated rates of hospitalizations and mortality, have been in decline over the past couple of decades, attributed in part to complex changes in the risk factors for peptic ulcer disease, including reductions in the prevalence of h pylori infection, the widespread use. An understanding of surgical management remains important since surgery is the mainstay of emergency treatment of these lifethreatening complications and for disease that is refractory to medical management.
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. Vital signs assessed for indicators of anemia tachycardia, hypotension, fecal occult blood checked against. Peptic ulcer disease pud affects four million people worldwide. Elective surgery is uncommonly needed for peptic ulcer disease in current medical practice. Perforations of the stomach and duodenum are common complications of peptic ulcer disease pud, abuse of non steroidal anti inflammatory drugs nsaids. Pdf management of nsaidassociated peptic ulcer disease. Currently accepted indications, elective and emergent, for surgery in the management of peptic ulcer disease include bleeding, perforation, obstruction, intractable disease, and suspected malignancy. Introduction peptic ulcer disease represents a serious medical problem. Peptic ulcer disease has declined significantly since 1950 in industrialized nations. The symptoms of a perforated ulcer include sudden, sharp, severe pain. Perforated peptic ulcer ppu is a serious complication of pud and patients with ppu often present with acute abdomen that carries high risk for morbidity and mortality. Perforated peptic ulcer 50 years ago perforated peptic ulcer was a disease of young men today it is a problem seen mainly in elderly women overall incidence for admission with peptic ulceration is falling the number of perforated ulcers remains unchanged sustained incidence possibly due to increased nsaid in elderly 80% of perforated duodenal.
The aim of this case report is presentation of a case with gastric perforation without apparent manifestation and risk factor for peptic ulcer disease. Signs and symptoms of a perforated peptic ulcer healthfully. A peptic ulcer is a sore in the lining of the stomach, where it is called a gastric ulcer, or the first part of the small intestine, called a duodenal ulcer. Descriptive epidemiology, risk factors, management and prevention. Perforated peptic ulcer ppu is relatively rare, but lifethreatening with the mortality varying from 10% to 40% 2, 46. Theyre usually formed as a result of inflammation caused by the bacteria h. Although a perforation may be the first indication of peptic ulcer disease, most people with this condition experience milder symptoms in the days or weeks leading up to the perforation. It is relatively uncommon in women of childbearing age, but it has been observed in children and even in infants.
Pdf guidelines of treatment for peptic ulcer disease in. Fortunately, integrative interventions including deglycyrrhizinated licorice dgl, zinccarnosine, and lactobacillus reuteri have powerful ulcerhealing. Elective peptic ulcer surgery was common before the discovery that peptic ulcer is caused by h. Peptic ulcer disease is a general term used to describe a breakdown in the lining of either your stomach gastric ulcer or the first part of your small intestine duodenal ulcer. Ulcers are caused by acid eroding the lining of the gastrointestinal tract. Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. Review article an overview of history, pathogenesis and. Typical pain pattern in du occurs 90 min to 3 h after a meal and is frequently relieved by antacids or food. The incidence of pud has been estimated at around 1. It is crucial to identify parameters to assess the severity of the disease i. A circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by helicobacter pylori infection. Sometimes an ulcer eats a hole in the wall of the stomach or duodenum. Notably, the presentation of peptic ulcer disease in lowincome and. Definition peptic ulcer disease involves ulcers, circumscribed breaks in the mucosa, involving the duodenum duodenal ulcers, the stomach gastric ulcers and less commonly the distal esophagus and the jejunum.
Presentation and management of perforated duodenal ulcer. Emergency surgery for perforated ulcer with mortality of 630%. Antrectomy including the ulcer with a billroth i anastomosis is the treatment of choice for an antral ulcer. Bacteria and partially digested food can spill through the opening into the sterile abdominal cavity peritoneum. Peptic ulcer disease pud affects 4 million people worldwide annually. Complications are encountered in 10%20% of these patients and 2%14% of the ulcers will perforate 2,3. It is the presence of ulcerations in gastrointestinal tract, which is characterized by being acidic, extremely painful. The pathogenesis of peptic ulcer disease may be considered as a combination scenario involving an imbalance between defensive factors mucusbicarbonate layer, prostaglandins, cellular regeneration, mucosal blood flow and aggravating factors hydrochloric acid, pepsin, ethanol, bile salts, drugs. However, the number of patients with perforated and bleeding ulcers has been constant or has declined only slightly, except for older patients, in whom the frequency has increased. Jsge revised the evidencebased clinical practice guidelines for peptic ulcer disease in 2014 and has created an english version. There may be some epigastric tenderness, but often there are no other signs on physical examinatio. Physical examination and abdominal palpation performed to localize tenderness.
Peptic ulcer disease peptic ulcers are focal defects in the gastric or duodenal mucosa that extend into the. Apr 12, 2019 the nursing goals of a client with a peptic ulcer disease include reducing or eliminating contributing factors, promoting comfort measures, promoting optimal nutrition, decreasing anxiety with increased knowledge of disease, management, and prevention of ulcer recurrence and preventing complications. Perforated peptic ulcers suny downstate medical center. Gitu, md, florida state university college of medicine family medicine. A perforated ulcer is a condition in which an untreated ulcer has burned through the mucosal wall in a segment of the gastrointestinal tract e. An overview of history, pathogenesis and treatment of. In the western world perforated duodenal ulcers du are much.
However, complications related to peptic ulcer disease continue to occur and include bleeding, perforation, and gastric outlet obstruction. Management of perforated gastric and duodenal ulcers. Prognosis becomes poor with age, delayed treatment, shock at admission and concomitant diseases. Guidelines of treatment for peptic ulcer disease in special conditions article pdf available in the korean journal of gastroenterology taehan sohwagi hakhoe chi 545. Peptic ulcer is a break like a sore in the lining of the stomach or the upper part of the small intestine 1, with a diameter of at least 0. Evidencebased clinical practice guidelines for peptic ulcer. A perforated ulcer can cause peritonitis, an inflammation of the abdominal cavity and wall.
The role of postoperative empiric helicobacter pylori eradication. Atypical presentation of perforated peptic ulcer disease. Peritonitis following prepyloric ulcer perforation. Atypical presentation of perforated peptic ulcer disease in a. The discovery changed the management of the disease, but still, its complication could be seen as an emergency in the form of perforation or bleeding2. An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines is a duodenal ulcer.
Mar 25, 2020 perforated and bleeding peptic ulcer clinical practice guidelines were released in january 2020 by the world society of emergency surgery. Helicobacter pylori hp in patients with suspected peptic ulcer disease pud. It is clear from the literature that perforated peptic ulcer disease is frequently not considered in the differential diagnosis of a child with peritonism leading to delays in management. Oct 04, 20 is there or is there job stress with family problems. Diagnosis of perforated peptic ulcer disease history and physical examination upright chest radiographs will show pneumoperitoneum free air in 8090% of the cases. Interestingly, those at the highest risk of contracting peptic ulcer disease are those. However, oheneyeboah et al11 reported a mean of 64. Here are five 5 nursing care plans ncp for peptic ulcer disease. Even though, deep ulcers or ulcers which have penetrated or perforated through the gastric wall can be detected.
The clinical presentation of gastroduodenal perforation is. Role of empiric antifungal therapy in the treatment of. From this study, perforated peptic ulcer disease commonly affected young and middle age group where the commonest age at presentation was between 21 and 50 years with a mean of 42. Peptic ulcer disease nursing care and management nurseslabs. Use of nonsteroidal antiinflammatory drugs nsaids and infection are the most common causes.
Ppt peptic ulcer disease powerpoint presentation free. What are the signs and symptoms of perforated peptic ulcer. Notably, the presentation of peptic ulcer disease in lowincome and middleincome countries, where the incidence of peptic ulcer disease is several fold higher than in highincome countries. Ulcers are caused by an infection of a bacterium known as helicobacter pylori or h. Complications of peptic ulcer disease include perforation and bleeding and improvement in medical management has made obstruction from chronic fibrotic disease a rare event. Complicated peptic ulcer disease emergency radiology assessment. A scarcity of highquality studies about the condition limits the knowledge base for clinical decision making, but a few published randomised trials are available.
Peptic ulcer disease occurs with the greatest frequency in people between 40 and 60 years of age. Peptic ulcer disease pud refers to the presence of one or more ulcerative lesions in the stomach or lining of the duodenum. Surgical therapeutic management of perforated peptic ulcer. Possible etiologies include infection with the bacterium helicobacter pylori most common, prolonged use of nonsteroidal antiinflammatory medicines possibly in combination with glucocorticoids, conditions associated with an overproduction of stomach acid. Jun 27, 2014 it is clear from the literature that perforated peptic ulcer disease is frequently not considered in the differential diagnosis of a child with peritonism leading to delays in management. Some symptoms associated with peptic ulcer disease, or a perforated gastric ulcer can include, but are not limited to bloody or dark tarry stools, fatigue, vomiting, and weight loss. Peptic ulcer disease pud pathophysiology is the property of its rightful owner. This protocol may be used by general practitioners, family doctors, and nurses.
Diagnosis and treatment of perforated or bleeding peptic. Evidencebased clinical practice guidelines for peptic. Fks perforated peptic ulcer and peptic ulcer disease. Sep 24, 2017 peptic ulcer disease may occur in both genders and in all ages. Thus, preadmission use of oral glucocorticoids is associated with up to a twofold increase in 30day mortality among patients hospitalized with perforated peptic ulcer. According to the centers for disease control, about 30% to 40% of people in the u. Risk factors peak incidence of duodenal ulcers between ages 25 and 50.
Complications to peptic ulcer disease include perforation. Jul 11, 2014 pathophysiology of peptic ulcer disease peptic ulcers occur when there is an alteration in the balance between acid production and mucosal protective mechanisms. Protocol for diagnosis and treatment of peptic ulcer in. The recommended biochemical and imaging investigations in the diagnosis of perforated peptic ulcer are as follows. Apr 17, 2020 patients with perforated peptic ulcer disease usually present with a sudden onset of severe, sharp abdominal pain. While the patient has several comorbidities, the gastric bleed and peptic ulcer disease will be the primary focus of the study. In the presence of risk factors, recurrence of ulcer is common despite initial successful treatment. Ppt peptic ulcer disease powerpoint presentation free to. The research surrounding environmental and social conditions. The patient was chosen for this study due to the severity of his condition and underlying malnutrition. If so, share your ppt presentation slides online with. Perforation is often the first clinical presentation of.
Every doctor, faced with a perforated duodenal ulcer of the stomach or intestine, must consider. A scarcity of highquality studies about the condition limits the knowledge base. All of these classic symptoms were presented in the patient at the time of his visit. Fk was admitted with severe malaise and fatigue with fainting spells at his home. Administration of antibiotics is standard treatment for. Peptic ulcer disease symptoms, treatment, pathophysiology.