Case 2 - peptic ulcers

Question 1

what are the three layers of the inner wall of the GI tract

Answer 1

epithelial layer
lamina propria
muscularis mucosa

Question 2

what does the epithelial layer do

Answer 2

absorbs and secretes mucus and digestive enzymes

Question 3

what does the lamina propria contain

Answer 3

blood and lymph vessels

Question 4

what does the muscularis mucosa do

Answer 4

smooth muscle that contracts and breaksdown food

Question 5

what are the four areas of the stomach

Answer 5

• carida
• fundus
• body
• pyloric antrum

look up a photo

Question 6

what closes when eating

Answer 6

the pyloric sphincter at the end of the stomach

Question 7

features of the cardia area epithelial layer

Answer 7

has mostly foveolar cells
these secrete mucus which is made up of water and glycoproteins

Question 8

features of the fundus and body epithelial layer

Answer 8

parietal cells that secrete hydrochloric acid
chief cells that secrete pepsinogen which is an enzyme that digests proteins

Question 9

features of the antrum epithelial area

Answer 9

G cells - secrete gastrin
also found in the duodenum and the pancreas

Question 10

what is the pancreas

Answer 10

an accessory gland to the GI tract

Question 11

what does gastrin do

Answer 11

stimulates parietal cells to secrete hydrochloric acid
stimulates growth of the glands

Question 12

where are Brunner glands located and what do they do

Answer 12

found in duodenum

secrete mucus rich in bicarbonate ions

Question 13

what do bicarbonate ions do

Answer 13

neutralise the acid in the stomach

Question 14

what has a thicker mucus layer - the stomach or duodenum and why

Answer 14

the stomach walls are constantly exposed to acid and therefore have a thicker mucus layer but in the duodenum, they are only momentarily exposed to acid and therefore have a thinner layer

Question 15

what also neutralises the hydrochloric acid

Answer 15

the blood coming to the stomach brings more bicarbonate

Question 16

what do prostaglandins do

Answer 16

stimulate mucus and bicarbonate

vasodilate nearby blood vessels and therefore more blood flow and therefore more epithelial cells growth

it also inhibits acid secretion

Question 17

what is H.pylori

Answer 17

gram negative bacteria
colonize in gastric mucosa

Question 18

what does h.pylori release

Answer 18

releases adhesions which helps them adhere to the gastric foveolar cells

also proteases which cause damage to mucosal cells

Question 19

where does the damage usually start

Answer 19

usually starts in the antrum and then spreads to the rest of the stomach and then eventually into the duodenum

Question 20

what do NSAIDs do

Answer 20

inhibit COX synthesis of inflammatory prostaglandins

leaves gastric mucosa susceptible to damage

Question 21

what is Zollinger-Ellison syndrome

Answer 21

tumour -> gastrinoma
Neuroendocrine tumour in duodenal wall or pancreas
Secretes abnormal amounts of gastrin
This leads parietal cells to release excess hydrochloric acid

Question 22

what are some of the features of ulcers

Answer 22

small ‘punched out’ holes in mucosa
Clean base
Scar tissue
Ulcers can bleed if erosion goes deep

Question 23

what can very deep ulcers cause

Answer 23

can cause bleeding

Question 24

what could happen if the ulcer is in the antrum

Answer 24

cause bleeding in the left gastric artery

Question 25

what could happen if the ulcer is in the duodenum

Answer 25

will cause bleeding in the gastroduodenal artery

Question 26

what does perforation allow for

Answer 26

gastrointestinal contents get into the peritoneal space which is usually sterile

Question 27

what is perforation a well known complication of

Answer 27

duodenal ulcers on the anterior wall of the duodenum

Question 28

what does this lead to

Answer 28

air collecting underneath the diaphragm

Question 29

what does this air collection lead to

Answer 29

irritation of the phrenic nerve and sends referred pain up to the shoulder

Question 30

what do long standing duodenal ulcers near the pyloric sphincter lead to

Answer 30

so much oedema or scarring
This then obstructs normal passage of gastric contents
Resulting in gastric outlet obstruction
Leads to nausea or vomiting

Question 31

what are some gastric ulcer symptoms

Answer 31

increased pain while eating
In presence of food and hydrochloric acid production
Therefore present with weight loss

Question 32

what are some duodenal ulcer symptoms

Answer 32

decreased pain while eating
Leads to weight gain

Question 33

what are the normal courses of treatment

Answer 33

combination of antibiotics
Acid-lowering medications
= proton pump inhibitors