ÇíÜÜÖÇ åÐÇ
ÞÑÍÉ ÇáãÚÏÉ æ ÇáÃËäì ÚÔÑ
Gastric & Doudenal ulcer
ãÇ åì ÇáÞÑÍÉ¿
Peptic ulcersare open sores or erosions in the lining of either the duodenum (duodenal ulcers) or the stomach (gastric ulcers).
- ÞÑÍÉ ÇáãÚÏÉ æÇáÃËäì ÚÔÑ ãä ÃßËÑ ÃãÑÇÖ ÇáÌåÇÒ ÇáåÖãì ÔíæÚÇð ¡ æÊÊÖãä ÃáÊåÇÈ ÈÈØÇäÉ ÇáãÚÏÉ æÍÏæË ßÔØ " ÊÃßá " Ýì åÐå ÇáÈØÇäÉ.
ããÇ íÌÚá ÌÏÇÑ ÇáãÚÏÉ Ýì ÍÇáÉ ÃÊÕÇá ãÈÇÔÑ ãÚ ÇáÍÇãÖ ÇáãÚÏì ¡ æåÐÇ íÓÈÈ ÔÚæÑÇ ÈÇáÍÑÞÇä æÚÏã ÇáÑÇÍÉ äÊíÌÉ ááÃáÊåÇÈÇÊ Ýì ÌÏÇÑ ÇáãÚÏÉ.
- æÇÐÇ ÍÏË Ðáß Ýì ÇáÃËäì ÚÔÑ ÊÓÈÈ ÞÑÍÉ ÇáÃËäì ÚÔÑ.
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ÃÓÈÇÈåÇ:
1- æÊÊÖãä ÃÏæíÉ Ãæ ÚÇÏÇÊ ÛÐÇÆíÉ ÎÇØÆÉ ÊÄÏì áÖÚÝ ÌÏÇÑ ÇáãÚÏÉ æÊÂßáå æÍÏæË ÇáÞÑÍÉ.
ÇáÃÏæíÉ:
Anti-inflamatory drugs:
Steroids:
as Cortisone and its derivatives:
(Hydrocortisone - Dexamethasone - Predinsolone - Betamethasone ,...)
Non steroidal (NSAIDs):
include Analgesic Antipyretics:
-Aspirin
-Ketoprofen
- Indomethacin
- Ibuprofen
-Diclofenac Na/K
Effect caused by:
-most drugs are weak acids , so cause Irritation & inflammation to Mucous membraine .
- Non selective Cox Inhibitors inhibit Cox 1 which is important for synthesis of useful Prostaglandin which have " Cytoprotective Effect " for Mucosa Against Hcl " Gastric acid " and Enzymes .
- cortisone and cortisone derivatives inhibit PLA2 " phospholopase A 2 " so inhibit XXXX PGs & LTs BioSynthesis.
Others:
Other drugs can induce P.U:
-parasympathomimetics "M1 receptor stimulation increase Hcl secretion".
-Reserpine
-Histamine "H2 receptor stimulation increase acid secretion"
- áÇíæÌÏÏæÇÁÝìÇáÕíÏáíÉíÍÊæì Úáì ÇáåÓÊÇãíä Ýì ÕæÑÊå Êáß æáßäå ÛÇáÈÇãÇíÓÊÎÏã áÃÛÑÇÖ ÊÔÎíÕíÉ.
- Stomachics & Digestants
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Excebtions
-Paracetamol
-Selective CoxII Inhibitors: which not affect or have little effect on Cox1 as Nimesulide - celecoxib.
- Opoid Analgesics as "Pethidine" not included in NSAIDs nor Corticosteroids and have no risk for induction of peptic ulcer.
N.B : Drugs that potentially induce peptic ulcer taken after meal.
2- ÇáÊÏÎíä ÇáÚÇÏÇÊ ÇáÛÐÇÆíÉ ÇáÎÇØÆÉ ãËá ÊäÇæá ÇáÞåæÉ æÇáÔÇì Úáì ãÚÏÉ ÎÇæíÉ Ãæ ÊäÇæá ÇáãæÇÏ ÇáÍÑíÝÉ ãËá ÇáÔØÉ æÇáÝáÝá ÈßËÑÉ .
3- ÇáÃÕÇÈÉ ÈãíßÑæÈ ÇáåíáíßæÈÇßÊÑ ÈíáæÑì
-"Helicobacter pylori" -
ÇáÍÇáÉ ÇáäÝÓíÉ : ÞÏ íÄÏì ÇáÖÛØ æÇáÚÕÈíÉ æäãØ ÇáÍíÇÉ ÇáÓÑíÚ Çáì ÇáÃÕÇÈÉ ÈÞÑÍÉ ÇáãÚÏÉ ¡ æåäÇß ÃÈÍÇË ÊÔíÑ Çáì Ãä ÇáÖÛæØ æÇáÔÏ ÇáÚÕÈì æÇáÊæÊÑ ÞÏ íÄÏì áÒíÇÏÉ ÃÝÑÇÒ ÇáÍÇãÖ ÇáãÚÏì æÇáÐì íÓÇåã Ýì ÍÏæË ÇáÞÑÍÉ.
4- ÒæáäÌÑ ÇáíÓæä
Zollinger Ellisone syndrome
æÑã ÈÇáÈäßÑíÇÓ Ãæ ÈÇáÃËäì ÚÔÑ íÓÈÈ ÒíÇÏÉ Ýì ÃÝÑÇÒ åÑãæä ÇáÌÇÓÊÑíä æÇáÐì ÈÏæÑÉ íÒíÏ ãä ÃÝÑÇÒ ÇáÍÇãÖ ÇáãÚÏì æÇáÐì íÓÈÈ ÇáÞÑÍÉ Ýì 85% ãä ÇáãÑÖì.
Zollinger-Ellison syndrome is a disorder where increased levels of the hormone gastrin are produced, causing the stomach to produce excess hydrochloric acid. Often the cause is a tumor (gastrinoma) of the duodenum or pancreas producing the hormone gastrin. Gastrin then causes an excessive production of acid which can lead to peptic ulcers (in almost 95% of patients)
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ÇáÃÚÑÇÖ ÇáÚÇãÉ:
- Ãáã ÈÇáÌÒÁ ÇáÚáæì ãä ÇáÈØä äÊíÌÉ áÊÃËíÑ ÍãÖ ÇáåíÏÑæßáæÑíß æÇáÐì íÝÑÒ ØÈíÚíÇ ÚäÏ ÈÏÇíÉ ÚãáíÉ ÇáåÖã.
- ÞÏ íÓÈÈ ÍÑÞÇä + ÑÛÈÉ Ýì ÇáÞÆ ÈÚÏ ÇáÃßá ãÈÇÔÑÉ.
- Ýì ÇáÍÇáÇÊ ÇáÔÏíÏÉ æÇáÊì Ãåãá ÚáÇÌåÇ : ÊÑÌíÚ ãÏãã Hematemesis
ÞÏ ÊÍÏË ÃäíãíÇ äÊíÌÉ ááäÒíÝ-
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ááÊãííÒ Èíä ÞÑÍÉ ÇáãÚÏÉ æÇáÃËäì ÚÔÑ:
ÞÑÍÉ ÇáãÚÏÉ :ÍÑÞÇä ãä ÑÈÚ Çáì ÓÇÚÊíä ÈÚÏ ÇáÃßá æÇáÐì ÊÎÝ ÍÏÊå ÈÇáÊÑÌíÚ Ãæ ÈÇáÞáæíÇÊ" ßÃÏæíÉ ÇáÍãæÖÉ" ãÚ ÝÞÏÇä Ýì ÇáæÒä æÑÈãÇ ÃãÓÇß ÇÍíÇäÇ
ÞÑÍÉ ÇáÃËäì ÚÔÑ:ÍÑÞÇä ÈÇáÌÒÁ ÇáÚáæìãä ÇáÈØä ÈÚÏ ÇáÃßá ÈÜ 2 - 4 ÓÇÚÇÊ æÇáÐì ÊÎÝ ÍÏÊå ÈÊäÇæá ÇáØÚÇã ÎÇÕÉ ÇáÏåæä "íÚÑÝ ÈÃáã ÇáÌæÚ" æíÚæÏ ËÇäíÉ ÈÚÏ ÚãáíÉ ÇáåÖã ßãÇ Çäå íÊÍÓä ÈÃÎÐ ÇáÞáæíÇÊ ãËá ÈíßÑÈæäÇÊ ÇáÕæÏíæã æÃÏæíÉ ÇáÍãæÖÉ æåäÇ íÍÏË ÒíÇÏÉ Ýì ÇáæÒä
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ÇáÃÎÊÈÇÑÇÊ ÇáÊÔÎíÕíÉ:
- x- ray Barium meal
-Endoscopy
-Biopsy
-Urea breath test
-F.T.M: fast test meal
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