Peptic Ulcer Pylori Case Study

1) Helicobacter Pylori associated chronic gastritis resulting in duodenal ulceration or Peptic Ulcer Disease.
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Gastric pain at night and when hungry: ulcer is duodenal as the pyloric sphincter is open.
Single punched-out lesion in the duodenum where 90% of peptic ulcers occur.
H.Pylori most common cause of peptic ulcers.
Erythematous stomach and history of dyspepsia: This indicates inflammation associated with chronic gastritis: result of long term hyperacidity in the stomach and duodenum.
Patient was a smoker. Smoking reduces blood flow and impedes healing of the epithelium and mucosa.
Presence of curved and spiral-shaped bacilli within the superficial mucosa of the antrum (no mention of the body of stomach) indicates
o Bicarbonate ions- neutralize acid, secreted by surface epithelial cells.
Gastric epithelium regenerates rapidly, replacing damaged cells.
Extensive blood supply to mucosa.

Predisposing factors:
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H. Pylori infection 80% of peptic ulcers
Smoking- reduces blood flow, impedes healing.
High-dose corticosteroid use (inhibits prostaglandin production)
More commonly seen in people with alcohol cirrhosis (alcohol stimulates gastric acid secretion), chronic obstructive pulmonary disease (reduces O2 blood perfusion), chronic renal failure and hyperparathyroidism (promote gastrin secretion).

3) Natural history:

o Peptic ulcers usually heal within weeks but reoccur within months(75% after one year) unless treated. o Longer healing indicates quicker reoccurrence unless stimulus is removed. o A longer period of symptoms before presentation is associated with poorer response to treatment.
Complications:

o Haemorrhage- (20% patients): o smaller vessels- anaemia o large vessel- malema or haematemesis o major artery: life threatening. o Perforation- spillage of GIT contents into peritoneum: leads to