Duodenal ulcer

 

Duodenal ulcer is the result of acid-pepsin digestion of the mucosa. Gastric hypersecretion is seen in most cases.

 

Causes of duodenal ulcer:

 

(1) Hyperacidity.

(2) Irregular dietary habits.

(3) Spicy diet, tea, coffee etc.

(4) Excessive smoking and alcohol habits etc.

(5) Improper chewing (inadequate mastication).

(6) Genetic factor.

(7) Endocrine factor – Zollinger Ellison syndrome multiple adenoma syndrome etc.

(8) Increased parietal cell mass.

(9) In some cases idiopathic.

 

Common site of duodenal ulcer: First part of duodenum. It is rarely seen at the posterior wall of second part of duodenum.

 

Characteristics of duodenal ulcers:

 

Ulcers occurring in the stomach and duodenum may be acute or chronic, the difference being that a chronic ulcer penetrates the muscularis mucosa, whereas an acute ulcer or erosion does not. Chronic ulcers occur with remarkable regularity in certain sites; in the stomach on the lesser curvature just above the angulus or less frequently at or near the pylorus, while duodenal ulcers occur within 1 cm. of the pylorus on the anterior or posterior wall. Acute lesions are frequently multiple and are less regularly distributed. Benign ulcers occur only rarely on the greater curvature or on the anterior wall of the stomach. [A chronic duodenal ulcer never becomes malignant; a chronic gastric ulcer may in 0.5% of cases.] S

 

Clinical features:

 

Symptoms – (1) Pain – gradual onset, Site – umbilicus, epigastrium. Pain in empty stomach, hunger pain, food relieves the pain after 2 to 3 hours, again pain starts.

(2) Burning sensation (heartburn) – acid eructation.

(3) Vomiting – rare.

(4) Malaena – maybe present (passage of black, tarry stool. (5) Appetite – increases (food relief pain).

 

Signs 

(1) Palpation – duodenal part is tender on deep palpation. (2) Inspection – nothing abnormal. (3) Percussion – nothing abnormal. (4) Auscultation – nothing abnormal. (5) General – healthy or obese.

 

 

 

Investigations for duodenal ulcer:

 

(1) Barium meal X-ray – presence of an ulcer crater of deformed duodenal cap or pyloric stenosis.

(2) Gastric function test – Augmented histamine test shows increase Rd content of gastric juice.

(3) Total night juice test – shows increased vagal activity.

(4) Occult blood test in stool – positive.

(5) Gastroscopy – may reveal ulcer in the stomach only.

(6) String test – may reveal the Site of hemorrhage.

(7) E.S.R. may be raised.

 

 

 

Complications of duodenal ulcer:

 

(1) Haematamesis and malaena.

(2) Shock.

(3) Perigastric adhesion.

(4) Pyloric stenosis.

(5) Perforation – peritonitis.

(5) Hourglass contracture.

 

Duodenal ulcer is differentiated from chronic gastric ulcer, stone in the gall bladder or kidney and chronic appendicitis by its characteristic pain. Diagnosis can be confirmed best by X-ray (B-meal, cholecystograph, U.S.G., C.T.Scan etc.) examination.

With careful dietetic treatment and regulate mode of life the prognosis is quite favorable.

 

Management of duodenal ulcer:

 

Medical Treatment

 

(1) Rest to body. Rest to mind and rest to ulcer.

(2) Diet – should be bland and nutritive, such as soft rice, boiled fish or egg, potatoes etc. Vitamin ‘C’, spice should be avoided.

(3) Smoking, tea, coffee, alcohol should be avoided; abstinence from these habits favours quick healing and reduces the chances of relapse.

(4) Food to be given every other hour or the third hour. Semisolid food in adequate quantity is to continue for several months.

(5) Antacids – Aluminium hydroxide gel and Magnesium oxide or trisilicate (most effective). If the bowel habit is loose the former drug and if the bowel habit is constipated the latter drug is usually prescribed.

 

 

 

Surgical Treatment

 

(1) Where the patient is not reliable.

(2) Pyloric stenosis.

(3) Recurrent haematamesis, malaena, perforation etc.

(4) When the patient cannot afford time for prolonged trial with medical treatment.

(5) A suspicion of malignancy.

Operative treatment – Gastrectomy or vagotomy and drainage operation, e.g., Gastro-jejunostomy or pyloroplasty.