Diseases of stomach and duodenum

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Diseases of stomach and duodenum

Manifested by pain; vomiting; bleeding; dyspepsia

Gastritis:
Most common stomach disorder.
Histological diagnosis – due to inflammation of the gastric mucosa.
Acute or chronic:
• acute – due to drugs (eg aspirin, NSAID’s, iron preparations); Helicobacter pylori; alcohol; viral infection; severe physiological stress (eg burns, multi-organ failure); irritating foot (eg hot peppers)
• chronic – due to autoimmune; Helicobacter pylori; tuberculosis; gastrointestinal disease (eg Crohn’s disease); sarcoidosis
Treatment – eliminate cause; symptomatic and supportive while healing takes place.

Peptic Ulcer:
Condition in which there is a discontinuity in the entire thickness of the gastric or duodenal mucosa. Can affect up to 10% of the population at some time. M2-5x>F.

Aetiology:
Helicobacter pylori infection (90%); NSAID toxicity (2nd most common reason); usually have family history  hereditary component; stress, smoking, caffeine and alcohol increases risk

Clinical features:
Episodic pain – located near base of sternum – usually more severe at night; usually occurs 1-3 hours after meal; relived by antacids, milk or food;

Complications – perforation (contents of stomach escape into peritoneal cavity); gastric outlet obstruction; bleeding

Management:
Lifestyle changes (stop smoking; relaxation; etc); antibiotics and proton pump inhibitor (eg omeprazole) for Helicobacter pylori infection; avoid aspirin and NSAID’s; antacids; histamine H2-receptor antagonist drugs (eg cimetidine); H+/K+ATPase (proton pump) inhibitors; surgical – partial gastrectomy

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