An ulcer (from Latin ulcus) is a lesion or eroded area on the surface of the skin or mucous membranes characterized by tissue disintegration and formation of pus. Essentially, it impacts the epithelium—the tissue that covers organs and surfaces of the bodies of animals, including both outside surfaces (the skin) and inside cavities. As such, an ulcer can impact such areas as the oral cavity and the gastrointestinal tract, the lower extremities, feet, the eyes (most often the cornea), and so forth. However, in common usage, ulcer often is used to refer to peptic ulcers, which are disorders in the part of the digestive tract that includes the stomach, proximal duodenum (and sometimes jejunum) in the small intestine, and the lower part of esophagus.
Causes of ulcers are varied and include injury, circulatory problems (failure of blood supply), infectious agents (bacteria, virus), diseases (typhoid, tuberculosis, bacillary dysentery, syphilis, leprosy, cancer), nutritional deficiencies, burns or other trauma, and so forth. Peptic ulcers, once attributed to stress are now commonly linked to infection by the bacterium Helicobacter pylori, as well as use to use of nonsteroidal anti-inflammatory drugs (NSAIDS, such as aspirin, ibuprofen, etc.), overproduction of digestive juices (Zollinger-Ellison syndrome), among others. Mouth ulcers are often tied to bacterial or viral infections.
In a certain sense, many ulcers are preventable. For example, Longe (2006) lists the use of NSAIDS (nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen) as the single most common cause of gastric ulcers. These drugs, which can be obtained without prescription, often are overused, as people look to treat symptoms of headaches, sore muscles, and other complaints without addressing the underlying causes of the complaints. Ulcers of genitalia are most often due to sexually transmitted diseases. Some ulcers are tied to nutritional deficiencies (such as thiamine) and ulcers of the lower extremities are often caused by circulatory problems, some of which may be tied to high cholesterol levels; these two issues are impacted by diet. Such causes reflect the importance of personal responsibility for one's health and perhaps the need for dietary or lifestyle changes.
Ulcers are healing wounds that develop on the skin, mucous membranes, or eye. Although they have many causes, they are marked by:
Essentially, there is disintegration of the tissue (death of cells and tissue), which opens up to the tissue below. The surrounding tissue becomes inflamed. There can also be complications, such as hemorrhage, perforation, and penetration. About five percent of peptic ulcer patients develop perforations: holes in the duodenal or gastric wall through which the contents can leak out into the abdominal cavity (Longe 2006). Penetration involves the ulcer eroding through the intestinal wall without digestive fluid leaking into the abdomen, but rather penetrating into an adjoining organ (Longe 2006).
The most common causes (not in order) are:
Longe (2006) reports that the single most common cause of gastric ulcers is the use of nonsteroidal anti-inflammatory drugs, or NSAIDS (aspirin, ibuprofen such as in Advil or Motrin, flubiprofen such as in Ansaid and Ocufen, ketoprofen such as in Orudis, and indomethacin, such as in Indacin). Aspirin is the one most likely to cause ulcers. The causes of duodenal ulcers are most commonly infection with the rod-shaped, gram-negative bacterium Helicobacter pylori (Longe 2006).
Some specific types of ulcers are:
Peptic ulcers include those that develop in the lower part of the esophagus, the stomach, the first part of the small intestine (duodenum), and the middle part of the small intestine) (jejunum) (Longe 2006). The most common peptic ulcers are gastric ulcers (in the stomach) and duodenal ulcers, with about 80 percent of all ulcers in the digestive tract being duodenal ulcers, and 16 percent being peptic ulcers (Longe 2006).
The following classification systems are used to communicate the severity and depth of an ulcer. It is an easy way to communicate changes for the better, or worse. The first two are not specific to the location.
This staging system for rating ulcers is designed to rate the severity of pressure ulcers.
This classification system is intended to rate the severity of diabetic foot ulcerations.
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