PATHOPHYSIOLOGY OF PEPTIC ULCER DISEASE

NON-MODIFIABLE RF: MODIFIABLE RF:

 Genetic predisposition  H. pylori infection
 Blood group O  NSAID use
 History of ulcer  Concomitant glucocorticoid, NSAID use
 Advanced age anticoagulant, or clopidogrel use.
 48 years old
 African-American race  Chronic disorders (chronic pulmonary
 Concomitant
glucocorticoid
disease, chronic renal failure, cirrhosis,
nephrolithiasis, AAT deficiency, Systemic
mastocytosis).
 Disorders with possible association
(Hyperparathyroidism, coronary artery
disease, polycythemia vera, chronic
 H. pylori eradication
pancreatitis, diabetes, psychological  Withdraw NSAID or shift
stress, former alcohol use, obesity, three to COX-2 selective
(PPI + Clarithromycin
+ Amoxicillin) or more doctor visits in a year).

H. pylori infection NSAID use

Laboratory:
Toxin release Rapid Urease Test Inhibition of COX-1 Mucosal cell injury
via production of
Inflammatory TNF and
Depletion of
response leukotrienes (pro-
prostaglandins
inflammatory
mediators)
Inhibition of H+
detection in antrum ↑ H+ production
↓ gastric mucous production

H+ over-secretion

↓ Gastroprotective factors: ↑ Mucosal injury:

Mucous: physiologic barrier between cells and HCl Acid: Gastrin, Histamin, ACh → promote acid secretion in parietal
Blood flow: removes H+, supports mucosal cells cells
Epithelial cells: physical barrier, HCO3- buffer Toxins: Drugs (NSAIDs) are directly toxic to gastric epithelial cells,
Prostaglandins: ↓H+ secretion, ↑ mucous production reduce platelet adhesion/plug

Postprandial
Proton pump pain
Erosion of mucosa inhibitors (PPIs)
Dx: Endoscopy Ulcers

Resuscitate IVF
PNSS 125cc/hr GI bleeding Irritation of somatic
innervation (T5-T8)

Anemia s/sx: Blood passes through GI Blood gets oxidized by HCl Bleeding into the Dyspepsia, Nausea
Dizziness tract, becomes oxidized by but moves back up to the esophagus Epigastric pain
Tachycardia HCl and digestion esophagus
Skin pallor
Pale palpebral
conjunctiva
Fatigue
Melena (Black tarry stool) “Coffee-ground” emesis Hematemesis
Pale nail beds
(vomiting of
blood)