| Disease |
PERTUSIS |
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| Quotation |
“A peptic ulcer is ahole in a man’s stomach through which he crawls to escape from his wife” |
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| Definition |
A chronic ulcer in the gastric or duodenal mucosa due to impairment of normal mucosal defenses by aggressive luminal factors like acid and pepsin. Could be rare in the distal oesophagus (Barret’s ulcer) or ectopic gastric mucosa (like in Meckel’s diverticulum) |
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| Prognosis |
Untreated, most cases od DU used to relapse within 2 years. H. Pylori eradication has lead to very low relapse rates. Intractable ulcers are very rare now. NSAID related ulcers occurs independent of H. Pylori status. |
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| General Measures |
Well balanced meals at proper intervals. Avoid tropical spicy and fried foods that aggravate pain. Avoidance of smoking, caffeinated drinks, cola, and more than small quantities of alcoholReduce stress.Avoid use of aspirin and NSAIDs |
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| Advice to Patient |
To be explained the role of smoking, alcohol, and diet, in ulcer symptomatology.Bismuth salts olour stools and tongue black, nad give ammoniacal odour to breath. |
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| Follow Up |
If symptoms persist, recheck for persistence of H. Pylori. If positive, a different regimen may have to be tried. For DU Clinical monitoring is adequate, unless symptoms recr, when re-endoscopy may have to be considered. For G U endoscopy required to ensure healing of ulcers especially if poorly healing or non-healing, ot rule out malignancy. |
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| Inadequate Response |
Could happen with non-eradication H. Pylori and a different combination may have to be tried as Metronidazole-resistant H.Pylori is being increasingly desribed. |
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| Prevention |
Eradication of H. Pylori has cut down recurrences to <10%Avoid indiscriminate use of NSAIDs. Where unavoidable, to use Misoprostol alongside or omeprazole |
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| Reference From |
Website: rxweb.nlu.edu/pharmacy/414/GIDrugs.htmwww.clevelandclinic.org/misc/surgical/general/peptic.html |
