Anatomy of chronic stomach ulcers

2021-05-12 04:20 PM

Genetic factors play an important role in duodenal ulcers, but not in peptic ulcers.

The disease often recurs many times, usually in the middle-aged and elderly. Rarely in young people. It can appear without causing any effect and then go away on its own after a few weeks to months. But usually, having an illness once is a lifelong illness. On the autopsy and patient monitoring surveys, it is found that the frequency of the disease is 6-14% in men, 2-6% in women. The rate of disease in men/women is 3/1 for duodenal ulcer and 1.5 / 1 to 2/1 for peptic ulcer disease. Menopausal women are more susceptible to the disease. About half a century ago, duodenal ulcers had a higher prevalence than today. The disease is often found in industrialized countries and is considered a disease of civilization.

Genetic factors play an important role in duodenal ulcers, but not in peptic ulcers. The immediate relatives of the sick person are 3 times more likely to get the disease than others.

Duodenal ulcers are more common in young or middle-aged men with type O blood. Gastric ulcers are more common in the elderly, with predominance in people with type A blood type A.

Recently, a causal link has also been found between the presence of Helicobacter pylori and gastric ulcer disease. Approximately 60-70% of peptic ulcer patients have H. pylori in the gastric mucosa.

Pathogenesis

Duodenal ulcers are often associated with nervous tension and anxiety. The ulcerated sites are the ones affected by gastric juice: stomach, duodenum, lower oesophagus, the peptic gap in the distal part of the gastrointestinal junction (after gastrointestinal coupling surgery). ), defects that contain gastric mucosa. The part of the mucous membrane that cannot tolerate the acid-pepsin environment is prone to ulcers. Therefore, stomach ulcers are common in the gastric cavity, rare in the heart.

An increase in gastric secretion and a touching factor is considered to be the source of an ulcer. The lining of the stomach and duodenum is always covered by mucus as well as by neutralizing and diluting the acidity by food, saliva, and duodenal fluid. The nocturnal increase in the secretion of hydrochloric acid in the stomach at night due to nerve stimulation is the cause of the duodenal ulcer. Stomach ulcers are caused by food stagnation in the stomach without a need to stimulate the secretion of hydrochloric acid.

However, a few cases of decreased acid secretion, especially in the cases of ulcers in the small curvature of the stomach without ulcers in the duodenum or pyloric, are due to a number of factors such as Inversion of bile, gastritis and a decrease in the mucus secretion of the gastric mucosa may decrease local resistance to hydrochloric acid.

Tactile factors that stimulate X-nerve via the hypothalamic-pre-lobe-adrenal cortex affect the functioning of the stomach. Cortisone, which can cause ulcers, usually in the stomach, can worsen ulcers, bleeding, or perforation.

Disease anatomy

Stomach ulcers are usually found on the posterior wall of a small curvature, about 5cm from the pylorus. A few cases in the heart, the pyloric sides (making it difficult to distinguish the location in the stomach or duodenum).

Duodenal ulcers are usually located about 1-2 cm from the pyloric, on the anterior wall or in the posterior wall (rarely on the sidewall).

A typical ulcer is usually small (about 1cm in the duodenum, 1-2.5cm in the stomach) covered with a glossy, well-lined, unobstructed layer of mucus clearly separated from the surrounding healthy mucosa. Sometimes the ulcer is large and irregular. Malignant gastric ulcers are usually cup-shaped, not covered with mucous membranes, have a steep edge, are tall and hard, and a thick submucosa.

Under the microscope, the ulcer base is covered with a layer of fibrin with polymorphonuclear leukocytes. The medial part is inflammatory granular tissue with cytoplasm, lymphocytes, sometimes with many eosinophilic polymorphonuclear leukocytes. The lower part is the non-vascular thick fibrous tissue that covers the defect of the smooth muscle layer. Occasionally, enlarged nerve bundles, embolized or fibrosis arteries are clearly visible. Many ulcers heal and the epithelium grows in a single layer. Gradually the glandular-like structure develops but never forms a completely normal mucus. Due to the thick fibrous tissue, the muscle tissue does not regenerate the permanent ulcer scarring.

Symptoms

Complications are pyloric haemorrhage, perforation, and congestion. These complications depend on the location of the ulcer. Ulcers of the stomach and duodenum can both cause severe bleeding. Duodenal ulcers often cause perforation. Any ulcer, especially in the posterior wall, can cause bleeding in small amounts, causing bleeding to occur.

Ulcers in the anterior duodenum wall can puncture the peritoneal sinus causing peritonitis. Perforation in the posterior wall into the pancreas can cause severe abdominal pain, causing localized peritonitis. The perforation can stick to the large junction and nearby structures, causing inflammation. Ulcerative peritonitis is initially chemical-induced inflammation, followed by bacterial infection.

Pyloric obstruction is a complication of an ulcer in the stomach or duodenum near the pylorus, caused by scar tissue and spasm. The stomach is enlarged and enlarged.

Carcinoma of a pre-existing ulcer occurs very rarely (less than 1% of cases).

Therapeutic post-operative ulcers can occur in the mouth connecting the gastrointestinal tract or in the distal part of the gap to the stomach. These new sores can cause perforation. Sometimes the hole opens and creates a fistula with the transverse colon.