Location and Type of Peptic Ulcer Diseases(PUDs)LocationandTypeofUlcer·PUDscanbedivided into1. Gastric Ulcer (GU)2. Duodenal Ulcer (DU)·PUDsoccurnearmucosaljunctions.·DUusuallyoccurattheduodenalpyloricjunction,:GU tend to occur at the oxyntic-antral junction,the antral-pyloric junction,orthe esophagogastricjunction
Location and Type of Peptic Ulcer Diseases (PUDs) Location and Type of Ulcer • PUDs can be divided into 1. Gastric Ulcer (GU) 2. Duodenal Ulcer (DU). • PUDs occur near mucosal junctions. • DU usually occur at the duodenal pyloric junction, • GU tend to occur at the oxyntic-antral junction, the antral-pyloric junction, or the esophagogastric junction
Location and Type of GUsType1GUmostcommon(60%70%).Typically,locatedonthelessercurvatureatorproximaltotheincisura,nearthejunctionoftheoxynticand antral mucosa.MostareassociatedwithdiffuseantralgastritisormultifocalatrophicgastritisType2GU(~15%)occurinthesameTableGastricUlcerTypeslocationasthetype1lesionbutareassociatedwitheitheractiveorTYPEACIDLEVELLOCATIONchronicduodenalulcerdisease1LowtonormalLesser curve at incisuraType3GU(20%)aretypicallylocatedIncreased三Gastricbodywith duodenal ulcerwithin2cmofthepylorus(pyloricIIIPrepyloricIncreasedchannel ulcer).IVNormalHigh on lesser curveType4GUrare,islocated intheVAnywhereNormal,NSAID-inducedproximal stomachorinthegastriccardia
Location and Type of GUs Type 1 GU most common(60%~70%). Typically, located on the lesser curvature at or proximal to the incisura, near the junction of the oxyntic and antral mucosa. Most are associated with diffuse antral gastritis or multifocal atrophic gastritis. Type 2 GU (~15%) occur in the same location as the type 1 lesion but are associated with either active or chronic duodenal ulcer disease. Type 3 GU (20%) are typically located within 2 cm of the pylorus (pyloric channel ulcer). Type 4 GU rare, is located in the proximal stomach or in the gastric cardia
FundusFundusPylorusBodyPylorusBodyIncisuraIncisuraTypeIgastric ulcerType IIAntrumAntrum0gastric uicerFundusFundusPylorusBodyPylorusBodyIncisuraIncisuraTypeIVgastric ulcerTypeIlAntrumCgastriculcerCAntrumA,Locationoftype1gastriculcer.B,Locationoftype2gastriculcer.C,Locationoftype3gastriculcer.DLocationoftype4gastriculcer.(FromKauffman GJrConterR:Stressulcerandgastriculcer.InGreenfieldLU,MulhollandMW[eds]:Surgery:ScientificPrinciplesandPractice.Philadelphia,JBLippincott,1993.]
A, Location of type 1 gastric ulcer. B, Location of type 2 gastric ulcer. C, Location of type 3 gastric ulcer. D, Location of type 4 gastric ulcer. (From Kauffman G Jr, Conter R: Stress ulcer and gastric ulcer. In Greenfield LJ, Mulholland MW [eds]: Surgery: Scientific Principles and Practice. Philadelphia, JB Lippincott, 1993.)
Clinical Manifestations1. Abdominal painPerforatedBiliary colic2. Bleedinggastriculcer3.PerforationPerforatedAcutepancreatitisduodenalulcer4. ObstrctionMeckel'sdiverticulumAcuteintestinalobstructionAcuteperforativeAcutediverticulitisappendicitisRupturedTorsionof ovaryovariancystAcute salpingitisEctopicpregnancy
Clinical Manifestations 1. Abdominal pain 2. Bleeding 3. Perforation 4. Obstrction
3.1 DU Essentials of Diagnosis·Epigastricpain relieved byfood orantacids..Epigastrictenderness..Normalorincreasedgastricacidsecretion.. Signs of ulcer disease on upper gastrointestinal x-rays or endoscopy·EvidenceofHelicobacterpyloriinfection
3.1 DU_Essentials of Diagnosis • Epigastric pain relieved by food or antacids. • Epigastric tenderness. • Normal or increased gastric acid secretion. • Signs of ulcer disease on upper gastrointestinal x-rays or endoscopy. • Evidence of Helicobacter pylori infection