Acute Peptic Ulcers

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Peptic Ulcers

Definition : Peptic ulcers are the areas of degeneration and necrosis of gastrointestinal mucosa exposed to acid peptic secretions. They occur most commonly (98-99%)  in either the duodenum or the stomach in the ratio 4:1. It may be acute or chronic.


Acute Peptic Ulcers / Acute Stress Ulcers 

Definition : Acute peptic ulcers are multiple, small mucosal erosions, seen most commonly in the stomach but sometime involve duodenum also.


Etiology : Most common cause of ulcers are stress -
1. Psychological stress
2. Physiological stress - 
  • Shock
  • Severe trauma
  • Septicemia or sepsis
  • Extensive burns (Curling's ulcers in the posterior aspect of the first part of the duodenum)
  • Intracranial lesions ( Cushing's ulcers developing from hyper-acidity due to excessive vegal stimulation) 
  • Drug intake (aspirin, steroids, butazolidine, indomethacin)
  • Local irritants (alcohol, smoking, coffee )

Pathogenesis :

  1. Mucosal digestion from hyper-acidity (important factor).
  2. Protective gastric mucus barrier may be damaged.



MORPHOLOGICAL FEATURES 

Grossly : Multiple ulcers (more than 3 ulcers in 75% cases) present in stomach but most common in the first part of duodenum. Ulcers are oval or circular in shape, usually less than 1 cm in diameter.

Histologically : Stress ulcers are -

  1. Shallow and do not invade the muscular layer.
  2. Margin and base show some inflammatory reaction depending upon the duration of ulcers.

COMPLICATIONS
  1. Haemorrhage.
  2. Perforation.



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