Duodenal ulcer is the result of acid-pepsin digestion of the mucosa. (Gastric hypersecretion is seen in most cases).
Causes of Duodenal Ulcers:
- Spicy diet, tea, coffee, etc.
- Excessive smoking, and alcohol habits, etc.
- Improper chewing (inadequate mastication)
- Endocrine factor – Zollinger Ellison syndrome multiple adenoma syndrome etc.
- Increased parietal cell mass.
- Irregular dietary habit.
- Genetic factor.
- In some cases idiopathic.
Common Sites of Ulcer Formation:
Ist part of the duodenum. Rarely posterior wall of 2nd part of the duodenum.
Pathology of Ulcers in the Body:
Acute lesions are frequently multiple and are less regularly distributed. Benign ulcer occurs only rarely on the greater curvature or on the anterior wall of the stomach.
A chronic duodenal ulcer never becomes malignant; a chronic gastric ulcer may in 0.5% of cases.]
Ulcers occurring in the stomach and duodenum may be acute or chronic, the difference being that a chronic ulcer penetrates the muscularis mucosae, whereas and acute ulcer or an erosion does not. Chronic ulcers occur with remarkable regularity in certain sites; in the stomach on the lesser curvature just above the angulus or less frequently at or near the pylorus, while duodenal ulcers occur within 1 cm. of the pylorus on the anterior or posterior wall.
Clinical Features and Duodenal Ulcers Symptoms:
Signs of Ulcer Formation:
Investigations related to Duodenal ulcers:
Barium meal X-ray – presence of an ulcer crater of the deformed duodenal cap or pyloric stenosis.
Gastric function test – Augmented histamine test shows increase
content of the gastric juice.
Total night juice test – shows increased vagal activity
Occult blood test in stool- positive
Gastroscopy- may reveal ulcer in the stomach only.
String test – may reveal the site of hemorrhage.
E.S.R. may e raised.
Complications related to ulcer formation:
Haematemesis and melaena.
Perforation – peritonitis.
Differential diagnosis of ulcers:
Duodenal ulcer is different from the chronic gastric ulcer, stone in the gall bladder or kidney and chronic appendicitis by its characteristic pain. Diagnosis can be confirmed best by X-ray (B-meal, cholecystograph, U.S.G., C.T. Scan, etc.) examination.
With careful dietetic treatment and regulate the mode of life the prognosis is quite favourable.
Management of a case of ulcers:
Here is the duodenal ulcers treatment-
(A) Medical Treatment :
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(B) Surgical Treatment:
Homoeopathic Remedies for Duodenal ulcers:
Carbo vegetalis– Burning in stomach, spreading down to small or back and up to the shoulders, Pain paroxysmal, takes away the breath. Bitter taste before and after eating. Vomiting of sour, bloody masses.
Anacardium– Symptoms disappear while eating and return soon afterThe constant sense of fermentation in abdomen, much rumbling, particularly in left hypochondria. Constipation stool hard. Worse from 4 to 8 p.m.
Colocynth – Frequent vomiting. Vomiting caused by pain, annoyance of distress may result in unbearable pain in any part of the body, causing vomiting Agonizing pain in the abdomen, only eased by bending double and pressing hard into the abdomen. Colic > by heat & pressure.
Robinia – An excellent remedy for heartburn and acidity. Everything turns to acid. “The chief keynote of Robinia is acidity, esp. if the time of <is night>.
Nux vomica– Putrid or bitter taste early in the morning. Frequent sour eructation. The region of the stomach is very sensitive to pressure. Cramp-like pain in stomach, with pressure, particularly after a meal. Water brash, heartburn.
Biochemic Remedies for ulcers:
Home Remedies for Duodenal Ulcers:
What should be included n the duodenal ulcers diet? Given below-
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