Small bowel (small intestine) - Duodenal peptic ulcer

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Small bowel (small intestine)

Ulcers

Duodenal peptic ulcer

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 15 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Decreasing incidence, but still common (Int J Clin Exp Pathol 2012;5:46)
● Imbalance between gastric acid production and protective factors of intact epithelium and bicarbonate production
● Increased gastric acid production requires intact fundic mucosa
● Associated with duodenal Helicobacter pylori and gastric metaplasia
● Not associated with malignancy

Treatment
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● H2 blockers
● 80% heal within a month
● Surgery if hemorrhage, perforation, obstruction or failure to respond to medical treatment
● Ulcers located posteriorly bleed easily due to pancreaticoduodenal and gastroduodenal arteries in the vicinity

Gross description
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● Usually single lesion within 2 cm of pylorus
● Multiple lesions throughout duodenum suggest Zollinger-Ellison syndrome
● Margins well defined
● No heaped up edges
● May have large vessel with open lumen at ulcer base
● Also fibrosis and shortening of duodenum

Micro description
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● Ulcer usually < 1 cm, circular, small
● Brown ulcer base (digested blood), no induration of margins of ulcer
● Abrupt lesions with normal adjacent mucosa
● No scarring or blood vessel thickening
● Gastric foveolar cell metaplasia and chronic duodenitis common
● Various villus abnormalities in proximal duodenum with active duodenitis
● Also Brunner’s gland hyperplasia
● Helicobacter pylori often present

Micro images
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Various images

Additional references
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● World J Gastroenterol 2010;16:5496

End of Small bowel (small intestine) > Ulcers > Duodenal peptic ulcer

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