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7.1: A Persistent Pain, History of gastric ulcer, Lifelong smoker (quit 5…

- - - - Histopathology: Chronic gastritis (neutrophil and mononuclear infiltrate) with numerous H.pylori organisms
      - Biochemistry: Raised urea
      - Toxins detected by receptors and transmitted via visceral afferents to vomit centre
        
        Nausea and vomiting
        
        Hypovolaemia
        
        Postural hypotension
      - H. pylori is detected by immune cells in the lamina propia
        
        H. pylori evades elimination by the immune system by activating TLR2/TLR9 and anti-inflammatory pathways
        
        Active chronic gastritis
        
        Increase in gastrin production
        
        Increase acid production by parietal cells
        
        Increased histamine release by ECL cells
      - Histopathology: No metaplasia, dysplasia or malignancy
        
        No weight loss
- - - - NSAIDs inhibit Cyclooxygenase 1 and 2
        
        Inhibition of COX 1/2 prevents prostaglandin synthesis
        
        Decreased PGE2
        
        Reduced bicarbonate & mucous secretion
        
        Reduced mucosal protective barrier
        
        Decreased defensive factors
        
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        Decreased PGI2
        
        Reduced perfusion of mucosal proliferative zone