When the pH is 2 to 3, pepsinogen is easily activated; Pepsin is inactive when pH is greater than 4

Long-term use of NSAIDs such as aspirin, ibuprofen, and indomethacin

Glucocorticoids, clopidogrel, bisphosphonates, sirolimus, etc.

Smoking, alcoholism, stress

radiotherapy

Combined with other diseases - gastrinoma, Crohn's disease, tumors

Viral infections—cytomegalovirus, herpes simplex virus, tuberculosis

Upper abdominal pain

Chronic

Periodicity: It occurs most often at the turn of autumn, winter, and winter and spring.

Rhythm: DU often has hunger pain, which is relieved after eating; GU often has postprandial pain

Abdominal pain can be relieved with acid suppressants or antacids

Localized tenderness under the xiphoid process and upper abdomen

Active ulcers in both stomach and duodenum

Higher incidence of pyloric deformation, stenosis, and obstruction

Pain that occurs soon after a meal

Prone to pyloric obstruction, bleeding and perforation

Ulcers occurring in the descending and horizontal segments of the duodenum

Pain may radiate to the right upper abdomen and back

Ulcers with a diameter of >2cm are common in patients with a history of taking NSAIDs and in elderly patients

Huge duodenal bulb ulcers are often located on the posterior wall and can easily develop into penetrating ulcers.

Not necessarily all malignant

elderly

child

The ulcer has not healed despite regular anti-ulcer treatment

possible factors

Mild cases - positive fecal occult blood test, melena

Severe cases - vomiting blood, dark red bloody stools

Penetration into the abdominal cavity causing diffuse peritonitis

Penetrate into parenchymal organs

Penetrating hollow organs - fistula

Upper abdominal distension and pain, which worsens after meals. The abdominal pain may be relieved after vomiting, and the vomitus may be caused by food.

Severe vomiting can cause water loss, hypochloremia, and hypokalemia alkalosis.

Gastric peristalsis waves, smell and vibrating sound

Inflammatory edema, pyloric smooth muscle spasm - temporary obstruction

Scarring and adhesion to surrounding tissue—persistent and progressive obstruction

GU is more common, but DU is also possible

First choice, "gold standard"

effect

GU Biopsy is routinely taken from the edge of the ulcer

Gastroscopy should be reviewed after 8 weeks of regular treatment

Applicable to

direct signs

indirect signs

HP test

Blood routine, fecal occult blood

Chronic liver, gallbladder, and pancreatic diseases, functional dyspepsia

The shape is often irregular, often >2cm, with irregular edges, uneven bottom and covered with dirty moss.

Frequently occurs in the "gastrinoma" triangle area: (The point where the gallbladder and common bile duct meet, The junction of the second and third parts of the duodenum, Within the triangle formed by the junction of the neck and body of the pancreas)

Multiple ulcers, atypical locations, prone to ulcer complications, poor response to regular anti-ulcer drugs

Diarrhea, high gastric acid secretion, elevated blood gastrin levels

Inhibit gastric acid secretion

Protect gastric mucosa

Cure HP

Take proper rest and reduce mental stress; Improve eating patterns, quit smoking, quit drinking, and drink less strong tea, strong coffee, etc.; Stop taking unnecessary NSAIDs and other drugs that irritate the stomach or cause nausea and discomfort; If it is necessary to take NSAIDs and other drugs, it is recommended to take them with food or after meals, or to add drugs to protect the gastric mucosa as directed by your doctor.

Hemostasis - surface spraying of protein glue, injection of epinephrine at the bleeding site, bleeding point clamping, thermal coagulation

Obstruction—endoscopic balloon dilatation

Applicable

complication