Ulcers , Michael K



Ulcers , Michael K. Davis, MD July 2009

"If you guys don't stop yelling, you'll give me an ulcer!"

"There's been so much stress at work lately, I'm sure I'll get an ulcer."

"Don't worry so much. Do you want an ulcer?"

When people talk like this, it sounds like ulcers are easy to give and easy to get. It also sounds like stress is to blame. But is that the real story?

What Is an Ulcer?

An ulcer is a sore, which means it's an open, painful wound. Peptic ulcers are ulcers that form in the stomach or the upper part of the small intestine, called the duodenum (pronounced: doo-uh-dee-num).Peptic ulcers are actually very common.

What Causes an Ulcer?

For almost 100 years, doctors believed that stress, spicy foods, and alcohol caused most ulcers. Now we know that most peptic ulcers are caused by a particular bacterial infection in the stomach and upper intestine, by certain medications, or by smoking.

In 1982, two doctors — Barry Marshall and Robin Warren — discovered a certain kind of bacteria that can live and grow in the stomach. Both doctors went on to win the Nobel Prize for their discovery. The medical name for these bacteria is Helicobacter pylori (or H. pylori, for short). Today doctors know that most peptic ulcers are caused by an infection from H. pylori.

Experts believe that 90% of all people with ulcers are infected with H. pylori. But strangely enough, most people infected with H. pylori don't develop an ulcer. Doctors aren't completely sure why, but think it may partly depend upon the individual person — for example, those who develop ulcers may already have a problem with the lining of their stomachs.

It's also thought that some people may naturally secrete more stomach acid than others — and it doesn't matter what stresses they're exposed to or what foods they eat. Peptic ulcers may have something to do with the combination of H. pylori infection and the level of acid in the stomach

How Ulcers Form

When H. pylori bacteria do cause ulcers, here's how doctors think it happens:

1. Bacteria weaken the protective coating of the stomach and upper small intestine.

2. Acid in the stomach then gets through to the sensitive tissues lining the digestive system underneath.

3. Acid and bacteria directly irritate this lining resulting in sores, or ulcers.

Although H. pylori are responsible for most cases of peptic ulcers, these ulcers can happen for other reasons, too. Some people regularly take pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, that fight inflammation in the body and are used to treat long-term painful conditions like arthritis. If taken in high daily doses over a long period of time, NSAIDs can cause ulcers in some people.

Smoking also is associated with peptic ulcers. Smoking increases someone's risk of getting an ulcer because the nicotine in cigarettes causes the stomach to produce more acid. Drinking a lot of alcohol each day for a period of time can also increase a person's risk of ulcers because over time alcohol can wear down the lining of the stomach and intestines.

In certain circumstances stress can help cause ulcers. But this usually only happens when illness involving severe emotional or physical stress is involved — such as when someone too sick to eat for a long period of time.

Ulcers occur because of uncontrolled increased acid production in the stomach and changes in the immune system (the body system that fights infection). With any illness where the body's ability to heal is challenged (such as when someone has serious burns from a fire), there is a risk for developing ulcers

Signs and Symptoms

Stomach pain is the most common symptom of an ulcer. It usually feels like sharp aches between the breastbone and the belly button. This pain often comes a few hours after eating. It can also happen during the night or early in the morning, when the stomach is empty. Eating something or taking an antacid medication sometimes makes the pain go away for awhile.

Other symptoms of ulcers can include:

• -loss of appetite

• -sudden, sharp stomach pains

• -nausea

• -frequent burping or hiccuping

• -weight loss

• -vomiting (if blood is in the vomit or the vomit looks like coffee grounds, which only happens with severe ulcers, call a doctor right away)

• -bloody or blackish bowel movements (this could indicate a serious problem, so call a doctor right away if you see this)

Anyone who thinks he or she may have an ulcer needs to see a doctor. Over time, untreated ulcers grow larger and deeper and can lead to other problems, such as bleeding in the digestive system or a hole in the wall of the stomach or duodenum, which can make someone very sick

How Are Ulcers Diagnosed?

In addition to doing a physical examination, the doctor will take a medical history by asking about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. If you have stomach pain or other symptoms of an ulcer, the doctor will perform some tests to help make the diagnosis.

One test is called an upper gastrointestinal (GI) series. This is a type of X-ray of the stomach, duodenum, and esophagus, the muscular tube that links the mouth to the stomach. A person drinks a whitish liquid called barium while getting an X-ray, and if he or she has an ulcer, it should be outlined on the X-ray.

Another common procedure to look for an ulcer is called an endoscopy (pronounced: en-dass-kuh-pee). During this test, the doctor uses an endoscope, a skinny, lighted tube with a special camera on the end.

A person getting an endoscopy is given anesthesia and will have no memory of the procedure. For an endoscopy, the doctor gently guides the endoscope into the throat and down into the esophagus, and finally into the stomach and upper intestines. The doctor is able to look at the inner lining of these organs from the camera on a television screen and can even take pictures. Tissue can be removed during an endoscopy and then tested for H. pylori bacteria.

A doctor can also do a blood test for H. pylori bacteria. This may be important if an ulcer is found in the upper GI series. The blood test can be done right in the doctor's office. Sometimes a bowel movement or a person's breath can also be specially tested to check for the H. pylori bacteria.

How Are Ulcers Treated?

Ulcers caused by H. pylori bacteria are generally treated with a combination of medications:

• -Usually two antibiotics to kill the H. pylori bacteria are taken every day for about 2 weeks.

• -Antacids — acid blockers or proton pump inhibitors — are given for 2 months or longer to lessen the amount of acid in the stomach and help protect the lining of the stomach so the ulcer can heal.

Ulcer Prevention

Doctors are not totally certain how H. pylori bacteria are transmitted from person to person. The bacteria have been found in saliva, so kissing may be one way. They also may be spread through food, water, or contact with vomit (puke) that has been infected with the bacteria.

The best advice in ulcer prevention is to always wash your hands after you use the bathroom and before you eat and to take good care of your body by exercising regularly and not smoking or drinking.

From

Appendicitis: Yamini Durani, MD

: September 2010

At first Miguel thought he had a "stomach virus," also called a gastrointestinal infection. His stomach hurt and he was throwing up. He wasn't hungry at all. But the next day, instead of feeling better, he felt worse. In addition to his other symptoms, he had a fever. Miguel's dad called the doctor, who asked them to come in right away. After examining Miguel, the doctor said they had done the right thing by calling because Miguel, as it turned out, had appendicitis and needed surgery.

What Is Appendicitis?

Appendicitis is an inflammation of the appendix. The appendix is a tube-shaped piece of tissue, the size of a finger, which connects to the large intestine at the lower right side of the abdomen. The inside of the appendix forms a pouch that opens to the large intestine.

Appendicitis can occur when the opening of the appendix to the large intestine gets blocked. Blockage can be due to hard rock-like stool (also called a fecolith), inflammation of lymph nodes in the intestines, or even parasites. Once the appendix is blocked, it becomes inflamed and bacteria can overgrow in it.

If the infected appendix is not removed, it can eventually burst or rupture from the buildup of pressure. This may happen as soon as 48 to 72 hours after symptoms start. The infection from a ruptured appendix is very serious — it can form an abscess (a walled-off infection of pus) or spread throughout the abdomen.

Symptoms of Appendicitis

The classic symptoms of appendicitis are abdominal pain and loss of appetite. Pain usually begins in the center of the abdomen, around the navel area. Later, the pain may move downward and to the right, to an area called McBurney's point, which roughly corresponds to the location of the appendix. The pain may be worse with moving, jumping, coughing, and deep breaths.

After abdominal pain begins, a person with appendicitis may develop a slight fever, have a loss of appetite, feel nauseated, or vomit. The pain can become steadily worse. If appendicitis isn't treated promptly, the infected appendix could rupture and the infection may spread to other areas of the abdomen and cause pain over the whole abdomen.

Of course, some of the symptoms of appendicitis can occur in a variety of illnesses. That's why it's important that you call your doctor to help make a diagnosis.

Development and Duration of Appendicitis

There is no specific incubation period (the time it takes for symptoms to develop) for appendicitis. Once the appendicitis symptoms appear, it can take as little as 48 to 72 hours for the infected appendix to rupture.

If the appendix ruptures, the infection will likely spread to other areas of the abdomen, increasing the risk of serious complications and making treatment more difficult.

When to Call the Doctor

If you suspect that you have appendicitis, call a doctor immediately. Appendicitis is an emergency that must be treated surgically. It can't be treated at home.

To help make a diagnosis, your doctor will ask you about your medical history and perform a physical exam. The doctor will usually do some blood tests and urine studies, and may recommend X-rays, a CAT scan, or an ultrasound examination. The doctor will decide whether you need surgery.

Ask before taking any pain medications (such as acetaminophen or ibuprofen) because your doctor will need to examine your abdomen for signs of pain and tenderness. Don't take laxatives or use enemas until your doctor sees you because these can cause the appendix to rupture.

Also, if your doctor suspects you have appendicitis, you will probably be asked to stop eating or drinking (an important precaution when a person is possibly going to have surgery).

Treating Appendicitis

Appendicitis is treated with surgery to remove the infected appendix. The operation is called an appendectomy. To prepare for the surgery a person will receive anesthesia. Anesthesia puts a person in a deep sleep and prevents pain.

An appendectomy generally has few complications, with a hospital stay of 1 to 3 days. However, if the infected appendix ruptures before surgery, the person usually stays in the hospital longer to receive antibiotics that will help kill bacteria that may have spread to the abdominal cavity. Even if the appendix has not ruptured, the doctor may prescribe antibiotics because they can decrease the risk of infection after surgery.

After a few days of rest at home, a student can safely return to school.

If You Think You Have Appendicitis

Get help from your doctor right away if you suspect that you have appendicitis, because this is a surgical emergency. Prompt treatment of appendicitis usually prevents complications and gets you back to your regular routine faster

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