Peptic Ulcer Disease

Question 1

What is a peptic ulcer?

Answer 1

Breakdown of mucosal barrier along the GI tract = subsequent injury d/t acid and pepsin (enzyme that breaks down proteins)

Penetrate through the entire mucosa to the submucosa, can affect one or all GI tract wall layers.

Question 2

Where do peptic ulcers commonly occur?

Answer 2

The duodenum, but also the stomach and esophagus.

Question 3

Do repeat ulcers occur?

Answer 3

Yes. Spontaneous remissions and exacerbations are common with duodenal ulcers. During remissions, the affected regional heals, the epithelium regenerates, and scar tissue forms. This region is weak and prone to recurrence (recurs in intervals of weeks or months if the underlying cause is not addressed).

Question 4

What does the gastric mucosal barrier consist of?

Answer 4

Formed by:
1) a bicarbonate-rich mucous layer
2) tight junctions that join epithelial cells = protects the stomach wall from injury d/t acid or pepsin

NOTE: peptic ulcers can occur when there is an imbalance between factors that protect the mucos and factors that cause damage to the mucosa.

Question 5

How do NSAIDS contribute to peptic ulcers?

Answer 5

Block the production of prostaglandins in the stomach (block COX-1) which are needed stimulate secretion of mucus for gastric mucosal barrier and increase gastric blood flow.

Exposes stomag wall to gastric acid and pepsin cuasing epthelial injury and progressive damage to underlying wall layers. Decreased blood flow impairs healing.

Question 6

What additional effects does aspirin have?

Answer 6

Weak acid and can penetrate the mucous barrier causing irritation.

Question 7

How does Helicobacter pylori infection contribute to peptic ulcers?

Answer 7

Cause of chronic gastritis, dyspepsia, peptic ulcers, gastric adenocarcinoma and lymphoma.