Peptic Ulceration Flashcards
This is a breach in the gastrointestinal mucosa as a result of ___ and _____ attack. Ulceration is longstanding and often deep
This is a breach in the gastrointestinal mucosa as a result of acid and pepsin attack. Ulceration is longstanding and often deep
The pathogenesis involves consideration of a number of factors including mucosal defence mechanisms, -____ metabolism, mucosal ___ flow and crucially the effect of ______
The pathogenesis involved consideration of a number of factors including mucosal defence mechanisms, prostaglandin metabolism, mucosal blood flow and crucially the effect of H.pylori
how are acute ulcers distinguished from chronic ones?
the absence of fibrosis
acute ulcers can occur in ___ ____ . and also in ____ ____
acute gastritis (NSAIDS or alcohol)
acute hyperacidity
what is the most common cause of acute hyperacidity?
most often due to gastrin-secreting neuroendocrine tumours (zollinger ellison)
but also in cushing’s
what are the symptoms of PUD
dyspepsia - very common cause of this
pain aggravated or relieved by eating
pain can be ____
nocturnal
what does pain that keeps you awake suggest about the cause of dyspepsia ?
it is organic .
People with functional dyspepsia can go back to sleep
duodenal ulcers are ____ by eating
relieved
gastric ulcers ____ by eating
aggravated
what accounts for most cases of PUD?
H.pylori
H.P is acquired in ______
infancy
what do HP look like ?
Gram negative microaerophilic flagellated bacillus
with H.P Can either have no pathology - the majority of people - Peptic ulcer disease - \_\_ -\_\_% - Gastric cancer - \_\_ %
Can either have no pathology - the majority of people
Peptic ulcer disease - 20-40%
Gastric cancer - 1%
what kinds of gastric cancer can be caused by HP ?
almost all non-cardia gastric adenocarcinoma
low gradeB cell gastric lymphoma - MALTOMA
what are some other causes of PUD?
NSAIDS (COX1, COX2 and PGE)
why is the duodenum the commonest site for PUD?
because the mucosa in the duodenum is much weaker when faced with acid
where in the stomach are ulcers common?
antrum and junction of body
where else can you get ulcers/
- oesophago-gastric junction
which cells are responsible for the secretion of acid
parietal cells
HP when infecting the stomach causes intense _____, increased ___ ____ and causes a _____ state. In duodenal ulcer pathology increased gastrin leads to increased ____ but no ___ of the cells
inflammation, blood flow, hyperacidic, acid, atrophy
In gastric cancer, there is increased ___ production which causes _____. This means that even though there is lots of ____ cells do not produce ____
gastrin, atrophy, gastrin, acid
duodenal ulcers
- Get increased gastrin release due to:
- decreased _______
- Cag +ve > Cag -ve - oncogenic, highly antigenic - Increased gastrin leads to
- Increased acid secretion
- Increased _____ cell mass
- No ____ gastritis - Leads to increased _____ acid load
- Get gastric _____
- HP colonisation and ulceration
- Get increased gastrin release due to:
- decreased somatostatin
- Cag +ve > Cag -ve - oncogenic, highly antigenic - Increased gastrin leads to
- Increased acid secretion
- Increased parietal cell mass
- No body gastritis - Leads to increased duodenal acid load
- Get gastric metaplasia
- HP colonisation and ulceration
how is H.Pylori diagnosed?
- gastric biopsy
- urease breath test
- FAT (faecal antigen test)
- serology (IgA antibodies)
