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PUD- NOT FINISHED - Coggle Diagram
PUD
- NOT FINISHED
Definition
a break in the lining of the mucosa
Sites
Lesser Curvature of Stomach
Proximal Ulcers: body of stomach
Distal Ulcers: antrum of stomach
First Part of Duodenum
Gastroesophageal Junction
Anastomotic Site (in cases of distal gastric resection)
Metaplastic/Heterotopic Gastric Mucosa
Etiology
NSAIDs
Smoking
H. pylori
Alcohol
Ingestion of Chemicals
Gastric Hyperacidity (Zollinger-Ellison syndrome)
Stress Ulcers: shock, sepsis, severe trauma
Curling Ulcers: severe burns/trauma
Cushing Ulcers: intracranial disease
Pathogenesis
Imbalance between mucosal defensive forces and damaging forces.
Defensive Forces
Epithelial Barrier: intracellular tight junctions
Subepithelial Barrier: rich gastric mucosal blood flow
Pre-Epithelial Barrier: mucus-bicarbonate layer
Damaging Forces
HCl
Pepsinogen
Complications
Gastric Outlet Obstruction, Gastrocolic/Duodenocolic Fistulas
Malignant Transformation
Perforation
Pancreatitis (due to posterior penetration of ulcer)
Upper GI Bleeding
Clinical Features
Abdominal Pain
May radiate to back, thorax, other parts of abdomen.
Duodenal ulcer relieved by food while gastric ulcer may precipitate on food.
Burning/Gnawing Discomfort
Episodic Pain
Epigastrium
Other Symptoms
retrosternal burning, water-brash, loss of appetite, acidic regurgitation, vomiting, fullness, bloating, anorexia, nausea, dyspepsia, hematemesis