UMY

Problem in this case

A 23 year old woman :

1.

Abdominal pain (2 months)

2.
3.
4.
5.

Four times a day

In the morning after eating

Vomiting after ingesting any food

Hematemesis
Melena
Hematochezia

Problem No. 1 2: Dyspepsia

Problem No. 1 4 : problems Upper gastrointestinal
disorders.
Problem No. 5: hematochezia Lower gastrointestinal
disorder

Hematemesis:

Melena:

Vomiting of blood or coffee fround like material

Black, tarry stools

Hematochezia:

Bright red or marron colored blood or fresh clots per-rectum

The distinctions based upon stools color are not

absolute.
Melena: can be seen with proximal lower GI bleeding
Hematochezia: massive upper GI bleeding

Dyspepsia

Episodic or persistent post pradial

epigastric discomfort or pain, nausea,
vomiting, early satiety, bloating,
distention, anorexia, and indigestion
Dyspepsia is symptom not disease

Causes of dyspepsia and

upper abdominal pain
A

Peptic ulcer disease

Gastroesophageal reflux
Gastroparesis
Malignancy of gaster
Cholelithiasis
Choledo cholithiasis
Chronic pancreatitis
Malabsorbtion
syndrome

Parasites
Medications (NSAIDs,
salisilate, etc)
Systemic conditions
(DM, thyroid disease,
CRF, etc)
Ischemic bowel disease
Neoplasma of abdomen
Non ulcer dyspesia

Dyspepsia devided 3 categorys

Dysmotility-like Dyspepsia
Ulcer-like Dyspepsia
Unspecified

Based on the prominents symptoms

Peptic ulcer (PU)

An ulcer due to the combined action of

acid and pepsin
Occurs :

in stomach
Duodenum
Jejunum (after gastro jejunal anestoneosis)

Peptic Ulcer:

Acute : lesion no fibrosis reaction in

the neugin or flooor if the ulcer
Chronic: fibrotic reaction surrounding
the ulcer
Acute : suddent on set and a short
duration
Chronic: more gradual on set,
prolonged duration

Pain of peptic ulcer:

Typically situated in the epigastrium. The

pain tends to occur half to 3 hours after
meals, to awaken the patient at night, to be
relieved by food, antacids and vomiting to
be characterized by remission and
exacerbations.
Some patients the symptom described as :
heartburn, fullness indigestion, distenstion,
discomfort.

AGGRESSIVE FACTORS
Acidic
environment

Mucus layer
Ionic gradient
Bicarbonate layer

NSAIDs

Gastric
Bile acid

H. pylori
Pepsin

Neutral environment

Prostaglandins
Surface epithelial
cells
Mucosal blood
supply

PROTECTIVE FACTORS
Imbalanced between aggressive factors and protective factors

Patogenesis ulkus peptikum

Asam + Pepsin = mukus + sel-sel

INFLAMASI + Faktor-faktor lokal = ULKUS

Cause of Formation
Of Digestive Ulcer
(Balance Theory)

+
Gastric acid
Pepsin
Drugs (such as NSAID)

Mucous membrane barrier

Stress

Mucus

Alcohol

Bicarbonate ion

H.pylori

Blood current the mucous

membrane

Free radical

Proliferating factoers

Offensive Factors

AG in the mucous membrane

Defensive factors

Internal secretion system

Central nerves system

Constitution
Heredity
Environment

Other Factors