ULCERS

Definition of Ulcer

1. Ulcer is a localised defect, or break in an epithelial surface, resulting from sloughing of superficial necrotic tissue
2. An ulcer is a crater-like lesion that may penetrate the epithelium and extend into the underlying tissue.

Classification of Ulcer

1. Peptic Ulcer → Gastric and duodenal ulcers, typically caused by Helicobacter pylori infection and NSAID use
2. Stress Ulcer → Also known as acute gastritis, caused by stress, shock, and severe illness
3. Chronic Ulcer → Can be a result of gastric or duodenal ulcers, or from conditions like Zollinger-Ellison syndrome
4. Aneurysmal Ulcer → A type of gastric ulcer, often seen in the stomach
5. Malignant Ulcer → Typically associated with gastric cancer
6. Benign Ulcer → May be caused by conditions such as gastric or duodenal ulcers, gastritis, or Zollinger-Ellison syndrome

Causes of Ulcer

1. Helicobacter pylori infection → leading to peptic ulcer disease
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) → causing gastric mucosal damage
3. Stress → including physical or emotional stress
4. Smoking → increasing the risk of peptic ulcer disease
5. Excessive alcohol consumption → leading to gastritis and mucosal damage
6. Zollinger-Ellison syndrome → a rare condition causing excessive acid production

Clinical Features of Ulcer

1. Abdominal pain → often in the upper abdomen
2. Nausea and vomiting → may accompany abdominal pain
3. Anemia → may result from chronic blood loss
4. Weight loss → due to malabsorption and decreased appetite
5. Dyspepsia → a feeling of discomfort or pain in the upper abdomen

Investigations for Ulcer

1. Upper GI endoscopy → visual examination of the upper gastrointestinal tract
2. Endoscopic biopsy → to obtain tissue samples for histopathological examination
3. Barium swallow → X-ray examination of the upper gastrointestinal tract
4. Abdominal ultrasound → to evaluate liver and pancreatic function
5. Complete blood count (CBC) → to assess for anemia or infection

Complications of Ulcer

1. Perforation → leading to peritonitis and potentially life-threatening
2. Hemorrhage → resulting in significant blood loss
3. Stenosis → narrowing of the affected area
4. Obstruction → blockage of the affected area
5. Malignant transformation → conversion to gastric cancer

Management of Ulcer

1. Medications → such as proton pump inhibitors (PPIs) and H2 receptor antagonists
2. Surgery → for complications such as perforation or hemorrhage
3. Endoscopic procedures → such as clipping or thermal coagulation
4. Dietary modifications → avoiding spicy or acidic foods
5. Stress reduction → through stress management techniques

Therapeutics of Ulcer

1. Medications → to reduce acid production and promote healing
2. Dietary modifications → to reduce symptoms and promote healing
3. Stress reduction → to prevent exacerbation
4. Lifestyle modifications → such as quitting smoking or reducing alcohol consumption

Homoeopathic Approach to Ulcer

1. Antimicrobial remedies → to address infection and inflammation
2. Gastric remedies → to soothe and protect the gastric mucosa
3. Anti-inflammatory remedies → to reduce inflammation and pain
4. Stress-reducing remedies → to promote relaxation and reduce stress

Homoeopathic Medicines for Ulcer

1. Hepar sulphuris → for gastritis and ulcerative colitis
2. Lycopodium → for duodenal ulcers and gastritis
3. Phosphorus → for gastric ulcers and gastritis
4. Arsenic album → for gastritis and peptic ulcers

Examination of Ulcer

1. Inspection → visual examination of the affected area
2. Palpation → feeling the affected area with the fingers
3. Auscultation → listening to the affected area with a stethoscope
4. Percussion → tapping the affected area with the fingers
5. Endoscopy → visual examination of the affected area with an endoscope