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L7: Peptic Ulcer Disease - Coggle Diagram

- - - - Damages muscle & nerve tissues
    - - Dysfunction in one-way stomach
        
        Slower emptying into small intestines
        
        Alkali (from SI) into stomach
        
        Mucosal layer damage
    - - Damages protective barrier of GI wall
  - - - Digestive fluids
    - - Drugs
      - Dietary intake
  - - - Inhibits cyclooxygenase
        
        Inhibits prostaglandin synthesis
        
        Less mucus production for maintaining GI barrier protection
        
        GI ulceration
    - - Inhibit phospholipase
        
        Blocks prostaglandin synthesis
  - - - Endogenous stimulant of gastric acid secretion
  - - - Inadequate buffering of HCl (more HCl)
        
        Less bicarbonate secretion
        
        Acid injury
  - - - Stimulate adenylate cyclase
        
        More cAMP secretion
        
        More acid prod
    - - Stimulates acid secretion
  - - - Stimulate parietal cells
        
        More acid secretion
- - - - Produced in golgi, released to epithelial surface
  - - - Neutralize gastric acid
  - - - Repairs injury
  - - - Active analogue of PGE1
      - Used for patients using anti-infl drugs as therapy (e.g. arthritis)
- - - - H+ from carbonic anhydrase disassociation
        
        Carbonic anhydrase from mucus cells; disassociate to H+ and bicarbonate
      - Cl- from blood via exchange with HCO3-
    - - Acetylcholine
        
        Released by vagus nerve
        
        via parasympathetic NS
        
        Ca2+ influx
        
        More secretion & less pH
      - Histamine
        
        Released by gastric paracrine cells
        
        Antihistamines reduce acid secretion from ACH & gastrin as well.
        
        Stimulated by ECL, more ECL more histamine more acid
        
        Stimulate adenylate cyclase
        
        More cAMP
        
        More acid secretion
      - Gastrin
        
        Released from mucosal cells
        
        Polypeptide
        
        Ca2+ influx
        
        More H+ secretion & less pH
        
        Less gastrin released (neg feedback)
        
        Less H+ secretion
        
        Less H+ (antacids) from neutralization
        
        More gastrin released
        
        1 more item...
        
        Antacid use is short-lived.
        
        Hormone inhibition (natural mechanism)
        
        Secretin
        
        High H+ in gastric contents reach duodenum, released by intestinal mucosa
        
        Less gastrin released
        
        More bicarbonate
        
        1 more item...
        
        Cholecystokinin
        
        From intestinal mucosa when fats/aa in digestive fluids
        
        Less gastrin released
        
        Gallbladder contraction
        
        2 more items...
        
        Glucagon
        
        Gastric inhibitory peptide (GIP)
        
        Somatostatin
  - - - via Gi protein
      - Less cAMP
        
        less acid secretion
        
        cAMP & Ca2+ activates protein kinase
        
        More vesicles containing H+ pump
        
        More cAMP, more acid secretion
- - - - Ulceration
      - Oxidative damage
- - - - Bothersome for long term use
    - - Not in large qty
        
        Excess Na+ may worsen CVD (heart swelling)
    - - Mg(OH)2
        
        Diarrhea side effect
      - Al(OH)3
        
        Constipation side effect
      - Maalox & Mylenta use mixture of both
  - - - E.g. Zantac
    - - Histamine antagonist
  - - - Irreversible binding to H/K/ATPase
      - Long-lasting (one dose a day)
      - Highly selective to stomach parietal cells
    - - Inhibits Ach, histamine, gastrin effect on parietal cells
  - - - PGE1 analogue/substitution
        
        Used by NSAID users
    - - Forms protective gel coating
        
        Prevents pepsin damage
      - Use with other drugs to reduce recurrence rate
      - Inhibit pepsin
  - - - Triple therapy is optimal (1-4 wks)
        
        Bismuth
        
        Tetracycline
        
        Metronidazone