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Gastric ulcers and duodenal are relatively frequent clinical entities
At the moment the most exactly method to detected the ulcers is videoendoscopy
of the upper digestive tract. The doctor eases a gastroscope, a thin tube
containing a tiny camera, through your mouth and down into your stomach
to look at the stomach lining.
The symptoms can be diverse but they can vary from patient to patient
which can be that an ulcer evolves without causing pain, until extremely
severe pain which can interrupt the patient´s dream. Differential
diagnosis are of other diseases into abdominal wall, gastric level, gallbladder,
pancreas etc. It is important to emphasize that there are some people
confused with this disease since, somebody or doctor said to them that
they even had ulcer without endoscopy and they think that all the life
will have the ulcer but nevertheless it is necessary to emphasize that
the ulcers are completely curable with the modern treatment that the doctors
used. The ulcers as much gastric as duodenal are cured but taking
in a month with suitable processings. The danger of an ulcer is the
complications that can cause which can put in danger the life of a patient
as they are bleeding, perforation. If after a month with the processing,
the symptoms persist it can be that the ulcer is hiding a gastric cancer.
See photos and videos of some ulcers detected by videoendoscopy in our
clinic.
| ENDOSCOPY Endoscopy provides a sensitive, specific,
and safe method for diagnosing peptic ulcers, allowing direct inspection
and biopsy. Determining the sensitivity of endoscopy depends upon
the gold standard used for comparison |
| HELICOBACTER PYLORI There is a strong relationship
between H. pylori infection and the development of peptic ulcer disease.
Peptic ulcer changed dramatically in the 1980s with reports of a causal
association between Helicobacter pylori infection and ulcer disease,
particularly duodenal ulcer. Although this concept met with a great
deal of initial skepticism, the association is now universally accepted.
It is now the accepted standard of care to test for H pylori infection
in all patients with either an active ulcer or just as important a
past history of ulcer disease. However, this is far from being the
"end of the story" for ulcer disease. For many patients,
it is appropriate to consider ulcer disease as a treatable (and curable)
complication of a chronic bacterial infection |
| There are four major complications of peptic ulcer:
Bleeding: Upper gastrointestinal
(UGI) bleeding secondary to peptic ulcer is a common medical condition
that results in high patient morbidity UGI bleeding commonly
presents with hematemesis (vomiting of blood or coffee-ground like
material) and/or melena (black, tarry stools). Hematochezia,
usually a sign of a lower GI source, can also be seen with massive
UGI bleeding. A nasogastric tube lavage which yields blood or coffee-ground
like material confirms this clinical diagnosis; however, lavage
may be negative if bleeding has ceased or arises beyond a closed
pylorus.Most patients with bleeding ulcers can be managed with fluid
and blood resuscitation, medical therapy, and endoscopic intervention,
as appropriate. The mortality from peptic ulcer
bleeding has not changed materially in recent years and remains
at 7% to 10% despite advances in patient management. Those found
to have bled from an ulcer should receive endoscopic hemostatic
therapy (eg, with injection sclerotherapy and/or the application
of a thermal coagulation device such as the heater probe) if there
is active bleeding, a non bleeding visible clot, or possibly an
adherent clot in the ulcer base (although the last remains somewhat
controversial).
Perforation: Duodenal, antral, and gastric body
ulcers account for 60, 20 and 20 percent of perforations due to
peptic ulcer, respectively . One-third to one-half of perforated
ulcers are associated with NSAID use; these usually occur in elderly
patients
Penetration:Ulcer penetration refers to penetration of
the ulcer through the bowel wall without free perforation and leakage
of luminal contents into the peritoneal cavity. Surgical series
suggest that penetration occurs in 20 percent of ulcers, but only
a small proportion of penetrating ulcers become clinically evident
.Penetration occurs in descending order of frequency into the pancreas,
gastrohepatic omentum, biliary tract, liver, greater omentum, mesocolon,
colon, and vascular structures. Antral and duodenal ulcers can penetrate
into the pancreas. Penetration can also involve pyloric or pre pyloric
ulcers penetrating the duodenum, eventually leading to a gastroduodenal
fistula evident as a "double" pylorus. A long-standing
ulcer history is common but not invariable in patients who develop
penetration Penetration often comes to attention because of a change
in symptoms or involvement of adjacent structures. The change in
symptom pattern may be gradual or sudden; it usually involves a
loss of cyclicity of the pain with meals, and loss of food and antacid
relief. The pain typically becomes more intense, of longer duration,
and is frequently referred to the lower thoracic or upper lumbar
region.The diagnosis of penetrating ulcer is suspected clinically
when an ulcer in the proper region is found. Mild hyperamylasemia
can develop with posterior penetration of either gastric or duodenal
ulcer, but clinical pancreatitis is uncommon .Penetration can be
associated with a wide array of uncommon complications including
perivisceral abscess (evident on CT or ultrasonography)], erosion
into vascular structures leading to exsanguinating hemorrhage (aortoenteric
fistula) , or erosion into the cystic artery . Rare biliary tract
complications include erosion into the biliary tree with choledochoduodenal
fistula, extra hepatic obstruction, or hematobilia. Fistulization
into the pancreatic duct has also been reported with penetrating
duodenal ulcer fistulae are seen with greater curvature gastric
ulcers, particularly marginal ulcers . Typical features of this
complication include pain, weight loss, and diarrhea; feculent vomiting
is an uncommon, but diagnostic symptom. A duodenocolic fistula can
also occur .No rigorous studies are available to guide the management
of penetrating ulcers. One can assume that management should follow
the intensive measures outlined for refractory ulcers.
Obstruction:Gastric outlet obstruction is the
least frequent ulcer complication. Most cases are associated with
duodenal or pyloric channel ulceration, with gastric ulceration
accounting for only 5 percent of cases.
NSAID's and Ulcer Disease. Nonsteroidal anti-inflammatory
drugs
Apart from H pylori infection, NSAID (or aspirin) use is the
other major identifiable risk factor for PUD. Accounts for the
majority of H pylori–negative ulcers.
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Endoscopic image of several gastric ulcer in a Female
87 years old with Multiple Gastric Ulcers She had a history of severe
epigastric pain from several months and has been under non steroid analgesics,
there are several big ulcers in the fundus and gastric body. (Click image
to see the video) for the best video performance would you please upgrade
your windows media. Click the media player and press Alt + Enter display
full screen.
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Gastric ulcer proximal to the gastric angle.For more endoscopic
details please
download the video clip clicking on the image. |
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This picture displays the endoscope
detecting a gastric ulcer. |
Next pictures display the sequence of Ulcers Healing
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| Ulcer of the posterior wall of gastric fundus. |
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| This endoscopic image shows, Ulcer development
Same case of above, Ulcer scarring and healing process after one month
of treatment. |
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Duodenal Ulcer and a pseudo diverticula
(arrow indicate) due to old ulcer scarring.
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"Salt and pepper ulcers" duodenal
bulb. |
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"Kissing" ulcers of the anterior
and posterior wall in the duodenal bulb, bleeding slowly. In the
past, most situations like this required emergency surgery and removal
of part of the stomach. Now with our newer technology, many bleeding
ulcers can be cauterized which stops the bleeding. In many cases,
surgery can now be avoided. |
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| Perforated ulcer, a 25 year-old man, this surgical picture display
a perforated ulcer that was diagnosis in laparotomy due to acute abdomen |
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| Same case as above. |
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