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Peptic Ulcer Disorder Flashcards

1
Q

______ comes up from the blood flow to neutralize the mucus layer on top of the stomach lining

A

bicarbonate

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2
Q

anything that _____ blood flow, you can start getting stress induced ulcers

A

reduces

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3
Q

What do superficial epithelial cells do?

A

Produce mucus and bicarbonate to neutralize acid and prevent damage to the lining of the stomach

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4
Q

What do chief cells do?

A

produce digestive enzymes (pepsinogen, chymotrypsin, gastric lipase)

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5
Q

What do parietal cells do?

A

produce HCl

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6
Q

What do G cells do?

A

produce gastrin

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7
Q

What do enterochromaffin-like cells (ELC) do?

A

release histamine

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8
Q

How does a drug like Zantac work?

A

Zantac surpresses the parietal cells that produce acid (HCl)

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9
Q

_____ binds to receptor on parietal cell and increases acid production

A

histamine

*see slide 6

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10
Q

What are examples of gastric acid producers?

A

acetylcholine
gastrin
histamine

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11
Q

What are examples of gastric acid (HCl) reducers ?

A

prostaglandins
somatostatin

  • these are good for stomach, it increases bicarbonate and mucous layer
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12
Q

Are NSAIDS (ex. aleve) good for people with stomach problems?

A

NO. They block production of prostaglandins.

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13
Q

Describe the layers of the stomach

A
  • mucus layer
  • bicarbonate layer
  • superficial epithelial ells
  • mucosal capillaries and sub mucosal arteries (blood)
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14
Q

What is the purpose of having mucus?

A
  • physical barrier that pepsin and other proteases cannot penetrate
  • slows pH gradient from 2-6
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15
Q

What is the purpose of the bicarbonate layer?

A

neutralizes H+

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16
Q

mucosal blood flow is critical for supplying ____

A

bicarbonate

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17
Q

What happens if there is an imbalance between gastric acid and mucosal defences?

A

-it can result in inflammation and damage to stomach lining leading to ulcerations

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18
Q

What 5 things reduce blood flow and therefore can lead to stomach ulcerations?

*IMPORTANT

A
  • drugs
  • alcohol
  • stress
  • smoking
  • immobility
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19
Q

Define: erosion

A

superficial injury caused by either:

  • decrease in mucosal defences
  • increase in gastric acid
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20
Q

Define: ulcer

A

complete erosion through the GI mucosa

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21
Q

What are the 3 main causes of PUD (peptic ulcer disease) ?

A
  • helicobacter pylori (most common)
  • NSAID induced
  • stress induced (uncommon)
22
Q

Can you die from a stomach ulcer?

23
Q

Define: gastritis

A

inflammation in the stomach

24
Q

Define: duodenitis

A

inflammation in the duodenum

25
What kind of ulcers are more common: duodenal or gastric?
duodenal
26
Describe H. pylori
- gram neg bacteria - spiral shaped - spread from person to person by fecal-oral route - it attaches to cells of the stomach and can stimulate the production of excess stomach acid - contracted through food and water
27
What are the 3 virulence factors of H. pylori ? *ON EXAM
H. pylori has genes that make it more capable of: - colonizing the stomach - penetrating through the mucous layer to evade the low gastric pH (kills superficial epithelial cells which produce mucus) - causing inflammation and cell death
28
Pathological properties of H. pylori: | Describe urease
ammonia produced can neutralize gastric acid allowing it to move from the stomach to the gastric mucosa
29
Pathological properties of H. pylori: | Flagella
allow penetration to mucus layer of the epithelial cells
30
Pathological properties of H. pylori: | Vac A = vacuolating toxin
- induces inflammation/apoptosis - promotes formation of acidic vacuoles inc ells - forms pores in epithelial cell membranes
31
Pathological properties of H. pylori: | LPS
recruits and activates immune cells - resulting in inflammation which kills epithelial cells
32
What is the most common symptom of PUD?
a gnawing or burning abdominal pain, usually in the area just beneath the ribs ``` other symptoms: weight loss loss of appetite bloating burping nausea etc. ```
33
If symptoms improve from eating = ____ ulcer
duodenal
34
If symptoms don't improve from eating = ____ ulcer
gastric
35
H. pylori attacks the normal gastric mucosa and causes _____ ______
acute gastritis
36
Acute gastritis then worsens into ____ ____ _____
chronic active gastritis
37
What can chronic active gastritis develop into?
Either: antral gastritis which produces a duodenal ulcer Or pan gastritis which produces a gastric ulcer
38
Describe the general pathogenesis of ulcers (either gastric or duodenal)
1. H. pylori infection 2. Inflammation stimulates increased release of gastrin 3. gastrin induces acid secretion from body of stomach 4. increased acid and inflammation damages mucosa causes ulceration
39
Describe 2 PUD symptoms of a gastric ulcer
- burning pain over a wide area below the breast bone | - precipitated by food!!
40
Describe 3 PUD symptoms of a duodenal ulcer
- focal pain between breast bone and belly button - pain releived by eating but will reoccur 1-3 hours after meals - pain worse at night
41
What is the most common noninvasive diagnostic method for PUD?
urea breath test | *downside - it's expensive
42
What is the most common invasive diagnostic method for PUD?
histology | *requires expert pathologist and biopsy
43
What are the 3 main lifestyle effects relating to PUD?
- alcohol consumption - smoking - cocaine/amphetamine (reduce blood flow which means less bicarbonate)
44
Are prostaglandins good in PUD? Why or why not?
Yes - stimulate bicarbonate secretion - mucous secretion - stimulate mucosal cell growth - decrease acid production
45
Why are NSAIDs bad? Why can they cause PUD?
Because they inhibit prostaglandin synthesis!! And prostaglandins are good!
46
Are muscarinic antagonists used?
Not really
47
What is the main treatment method to kill H. pylori ?
antibiotics
48
Are histamine H2 receptor antagonists used?
They are but are less common.
49
What is another part to the treatment of H. pylori ?
block H+ K+ ATPase
50
How many CCK2 receptor antagonists exist?
none

Pathophysiology (15 decks)

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