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PEPTIC ULCER - Coggle Diagram
PEPTIC ULCER
FEATURES
- In most cases - ulcer is located in duodenum usually above ampulla of VATER. In this area acidic chyme is not neutralized by alkaline pancreatic juice
Main feature - upper abdominal pain epigastric pain)
typically experienced in empty stomach and relieved by taking water, food, antacid
disease untreated - hematemesis or malena, vomiting and peritonitis due to perforation of ulcer into peritoneal cavity occurs
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PATHOPHYSIOLOGY
HELICOBACTOR PYLORI INFECTION
- gram nega bacteria
- secretes urease that converts urea into CO2 and NH3
- ammonia buffers acid surrounding the bacteria
- h. pylori colonizes antral mucosa - causes local inflammation & disrupts immune responses
- inhibits somatostatin secretion from D cells that facilitates gastrin release and consequently inc HCl secretion
- serum gastrin level moderately inc in duodenal ulcer
- h. pylori causes gastritis initially and ulcers later
- antibiotic therapy helpful
DIMINISHED EFFECTIVENESS OF MUCOSAL BARRIER
- mucosal defense barrier - mucus coat on gastric epithelium
- mucus cells secrete mucus - contains mucin, phospholipid, electrolytes and water
- mucus gel layer effectively separates bicarbonate rich secretion of epithelial cells from acidic content of stomach
- pH of epithelial cells is alkaline despite acidic pH of gastric contents
- protects mucosal epithelial cells from damage by acidic chyme
- mucus secretion impaired - HCO3- production decreased OR mechanically damaged
- acid and pepsin cause ulcer formation
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in chronic stress, ulcer is produced by chronically elevated levels of catecholamines in blood
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HYERSECRETION OF ACID
- chronic anxiety - gastric acid secretion increases
- peptic ulcer common in business executives - hurry, worry, curry
- intake of more spicy food - peptic ulcer
- chronic stress - induces gastric ulcer
- chronically increased secretion of acid - hyperchlorhydria - causes peptic ulcer
condition that cause hyperchlorhydria
a. Zolliger ellison syndrome
b. gastric outlet obstruction syndrome (ex: pyloric stenosis)
c. systemic mastocytosis (histamine from mast cells inc HCl secretion
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