Peptic Ulcer Disease: Pathophysiology, Etiology, Clinical Presentation, and Management, Exams of Pathophysiology

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PEPTIC ULCER DISEASE

By: Richa Agarwal Subject: Pathophysiology (Unit 3) II semester Maharishi Arvind Institute of Pharmacy

GASTROINTESTINAL SYSTEM DISORDER

OBJECTIVES

• Definition and pathogenesis of Peptic Ulcer
• Etiology
• Clinical Presentation
• Investigation/ Diagnostic test
• Complications of PUD
• Management

TYPES

• GASTRIC PEPTIC ULCER
• DUODENAL PEPTIC ULCER

ETIOLOGY OF PUD

• Helicobacter pylori- associated ulcers

• Nsaid-related ulcers.

• Hypersecretory states: z-e syndrome, idiopathic.

• Smoking

PATHOGENESIS OF PUD

• IMBALANCE BETWEEN AGGRESIVE AND DEFENSIVE FACTORS

H-PYLORI

H. Pylori transmitted by fecal-oral/ oral-oral route In the stomach it swims in viscous mucus due to flagella Organism attached to mucus- secreting cells of gastric mucosa by adhesins Production of large amount of ammonia from urea by bacterial urease Ammonia neutralizes HCl in stomach Organism survival Inflammator y response Damage to mucus Gastritis and peptic ulcers

NSAIDS Membrane phospholipids PhospholipaseA Arachidonic acid COX PG depletion Epithelial effects

• Increase in HCl secretion
• Decrease mucin secretion
• Decrease HCO3- secretion
• Decrease surface active phospholipids secretion
• Decrease epithelial cell proliferation NSAIDs inhibits Endothelial effects Stasis ischemia

COMPLICATIONS Hemorrhage

- Blood vessels damaged as ulcer erodes into the muscles GI Coffee ground vomitus or occult blood in tarry stools **Perforation

• An ulcer can erode through the entire wall
• Bacteria and partially digested food spill into peritoneum :Peritonitis** **Narrowing and obstruction (pyloric)
• Swelling and scarring can cause obstruction of food leaving stomach :** Repeated vomiting

DIAGNOSIS OF PUD

Stool examination for fecal occult blood. Complete blood count (CBC) for decrease in blood cells. Endoscopic procedure

• Visualizes ulcer crater
• Ability to take tissue biopsy to R/O cancer and diagnoseNH. Pylori Upper gastrointestinal series (UGI) - Barium swallow - X-ray that visualizes structures of the upper GI tract

DUODENAL ULCER

NATURAL HISTORY OF PUD

• PUD is a chronic episodic disease with relapses and

remissions.

• If left untreated, 30-40 % of ulcers heal within 8 weeks.

• Recurrence rate without treatment is 70% during first year

and 90% within 2 years.

• Complications develop in 20% of PUD

LIFE-STYLE MODIFICATION IN PUD

• DOUBTFUL EFFICACY
  • REST
  • RELAXATION
  • GOOD SLEEP
  • DIET:
    • BLAND DIET
    • FREUENT SMALL MEALS
    • CAFFEINE-CONTAINING BEVERAGES
    • ROLE OF MILK
    • FAT DIET
    • SPICES
    • ALCOHOL
    • FIBER
    • VITAMIN E AND DIETARY FATTY ACIDS