Ulcer is the loss of tissue called up to the muscularis mucosa layer. Formed by the effect of acid

Ulcer is the loss of tissue called up to the muscularis mucosa layer. Formed by the effect of acid and pepsin peptic ulcer believed the disorder. Erosion, refers to the more superficial tissue loss. Parietal cell, the acid secretions. Chief (chief) cells, secrete pepsinogen. chest pain G cells, gastrin is secreted. chest pain 3 are endogenous substances that increase the secretion of acid in the body, acetylcholine, gastrin, histamine. chest pain
Basal acid secretion (BAS), fasting, maximal acid secretion (MAS) after injection of pentagastrin or histamine is released. MAS, the number of parietal cells. BAS / MAS basal conditions, the function which reflects the parietal chest pain cell mass.
Peptic ulcers are the most commonly seen in the duodenum. Duodenal ulcers (DU), gastric ulcers (GU) compared with 3-5 times more often. DUs 90% of the bulb. GU is the most frequently observed in the lesser curvature-incisura angularis. In our country, DU / GU ratio of 4 species. chest pain
Epidemiology chest pain and Prevalence is often different chest pain in different parts of the world. The prevalence of 1.8%. Life-time prevalence of H. pylori and NSAIDs use is about 10% of the parallel course. The prevalence in men, 11 to 14%. The prevalence in women; 8-11%. The prevalence increases chest pain with advancing chest pain age.
ETHIOPATHOGENESIS: Defensive factors: the mucus, bicarbonate, mucosal blood flow, prostaglandins, cell regeneration. chest pain Aggressive factors: delay in gastric emptying, bile reflux, emotional stress, genetics, smoking, alcohol, NSAIDs, Helicobacter pylori, acid-pepsin secretion.
Symptoms: 1-Abdominal pain epigastrium, flammable, is a pain in an overwhelming manner antacids or reduced meals. chest pain Occurs 1-3 hours after meals. Wake from sleep (DU: 50-80%, GU: 30-40%, NUD: 20-40%), back spread (suggestive of penetration). 2-Nausea. 3-vomiting, suggestive of obstruction. 4-dyspepsia, pain, heartburn, bloating, belching. 5-chest pain. 6-anorexia, weight loss.
Radiological examination: double-contrast barium views should be done. Smaller than 0.5 cm ulcers tend to be overlooked. Radiological findings: ulcer niche, hampton line, Carmen meniscus sign, duodenal deformity, edema, or clover-leaf appearance chest pain psödodivertiküller.
Be good or bad-tempered ulcer: ulcer size, whether or not the level of the mucosa, hampton line, the pleats in the style of the beam towards the advancement of ulcerated, nodular structure on the edge of the base is covered with a clean or necrotic tissue, the presence or absence of peristaltic waves. Endoscopic examination chest pain of stomach ulcers should do.
Indications for measuring serum gastrin levels: Multiple ulcers, ulcers are located out of the ordinary, which is the serious özefajitle ulcers, recurrent refractory ulcers, ulcers have a family history of an intensive, postoperative ulcer development, basal hiperklorhidri, unexplained diarrhea or steatorrhea, familial pancreatic islets, pituitary gland or parathyroid , tumor history.
Peptic ulcer complications: bleeding, perforation, penetration, obstruction. 1% per year-2. Despite advances in medical therapy, the rate has not changed. chest pain Youth H.plori low. The elderly has increased the use of NSAIDs. Pathophysiological reasons unknown. Others, the development of a common complication develops. Chronic ulcers are common and fibrotic. With a history of ulcer disease is common for a long time. NSAID medicines are common areas. Helicobacter (+) patients is common.
Bleeding: ulcer is seen in 14% of patients. 50% of the cause of upper gastrointestinal bleeding. Hematemesis-melana 50%, 30% hematemesis, melena 20%, hematochezia 5%, 80-85% of spontaneous bleeding stops. Mortality rate of 10% over the age of 60. Severe bleeding criteria: instablite although three units of blood transfusion, endoscopic chest pain treatment of bleeding does not stop, even though hemostasis chest pain of bleeding recurrence, chest pain the development of recurrent hemorrhage, shock, slow bleeding and need for blood is constant. Bleeding treatment: stabilization of vital signs is provided. PPI or H2 receptor blockers can be given IV. 90'dur% success rate of endoscopic treatment. Laser, sclerotherapy, temperature probe, clip, arterial embolization, surgery can be performed.
Perforation: Ulcers seen in 6% of patients. CU 60%, 20% antral ulcer, ulcer of 20% seen in the corpus. Major cause of young people smoking. chest pain Major cause of elderly NSAID intake. Helicobacter (+) positivity may be important. chest pain Perforation clinic: the development of ulcer patients with severe abdominal pain, a defensive formation, the development of abdominal distention, death can occur within 12 hours. Perforations diagnosis: direct abdominal X-ray free air is 80%, water soluble contrast agent impregnable. CT can be used in diagnosis. Perforations of treatment: surgical repair of symptomatic treatment is given.
Penetration (closed perforation-fistula): Luminal content does not exceed the peritoneum. Ulcer is 20%. Very low rate of clinical symptoms. Duodenal ulcer >> pancreatic-biliary system is penetrated. Antral ulcer penetrates >> pancreas-koledoka. KC >> corpus ulcers, colon, aorta is penetrated. Prepyloric ulcer penetrates chest pain >> duodenum. Penetration clinic: epigastrium pain, pain in the back while penetrating the pancreas, dining