GI - Peptic Ulcer Disease (PUD) Flashcards
What is PUD? Where is it located? Provide %.
Ulceration in the upper GIT.
Located in duodenum (80%) and stomach (20%)
Incidence %?
10%
Is it curable? If yes, how so?
Yes. Antibiotics.
What protection does the stomach have that the duodenum does not? and vice versa
The stomach has a mucous layer that secrete mucous to protect from HCl
Pancreatic juice is released to the duodenum to neutralize acid with bicarbonate ions
Why are incidents higher in duodenum?
It depends on the action of pancreatic juice. If acid enters duodenum with no pancreatic juice then it is damaged.
Which layers of GIT is mostly impacted and where most ulcers are found?
The Mucosa
Can acid penetrate to deeper layers?
YES
Patient can experience chronic ____ and ____ if ___ and ____ or if _____ occur
remission and exacerbation
untreated and uneradicated
reinfection
Etiology: what bacteria is found in PUD?
Heliobacter pylori
Etiology: The site of attachment is ____. H. Pylori is part of the ____ flora.
epithelial lining
transient flora (colonizes in GIT)
Etiology: H. Pylori secretes ____ ____ to attach on surface of the duodenal/stomach wall
adhesion proteins/factors
Etiology: What enzyme does H. Pylori secrete? What does the enzyme do? How does it benefit the bacteria?
Urease = converts urea to CO2 and NH2
Ammonia (NH2) is basic and can neutralize the gut acid in the vicinity of the bacteria
CO2 combines with H2O in the stomach to produce H2CO3 (carbonic acid) which dissociates rapidly to bicarbonate ion and hydrogen ions. Bicarbonate ions buffers the HCl to protect bacteria
The bacteria creates a _______. How does it benefit the bacteria?
Microenvironment/micro-niche:
an area surrounding the bacteria that is neutralized to protect the bacteria from the gut acid
What are the protective factors of the GIT? (4)
- mucous lining of the stomach
- regeneration of the mucosa
- regulation of the acid secretion
- good perfusion
What are the risk factors of PUD? (5)
- HCl and biliary acid (secreted in stomach and found in bile)
- Chronic Gastritis (acid impact damaged tissues d/t inflm)
- NSAIDs (impairs healing and regeneration of mucosa, irritate mucosa, decrease syn. of PG)
- Smoking and alcohol (aggravate lining of the gut)
- H. Pylori