PATHOPHYSIOLOGY OF PEPTIC ULCER DISEASE.pptx

PATHOPHYSIOLOGY OF PEPTIC ULCER DISEASE

1. PATHOPHYSIOLOGY OF PEPTIC ULCER DISEASE BY, DR. JOHN T QUWANGA

2. INTRODUCTION Definition Peptic ulcer is the break in the continuity of the mucosal lining of the stomach or duodenum. It is due to imbalances between mucosal lining defense system and gastric juice secretion. Under normal circumstances the gastric juice secretion are in balance with the mucosal lining defense such that the physiological function of the stomach and duodenum are not affected. Acid secreted are channeled to the lumen and digestive enzymes are secreted in an inactive form.

3. SECRETION OF GASTRIC ACID Gastric acid are secreted by parietal cells. Its secretion is stimulated by Gastrin hormone secreted by the G cells Neural stimulation via vagus nerve Enterochromaphine like cells Somatostatin inhibit acid secretion These secretions occurs in three phase Cephalic phase Gastric phase Intestinal phase Gastric acid gives favorable PH for enzymes activity in the stomach, activate pepsinogen and kill microorganism.

4. MUCOSAL DEFENSE MECHANISM Mucosal lining with tight junctions Mucus secretions containing mucins and bicarbonate Prostaglandins E Nitric oxide Physiological blood supply with effective mucosal epithelial regeneration

5. PATHOPHYSIOLOGY Mucosal damage can occur whenever the defense mechanism is impaired either through hypersecretion of the juices or direct impairment of the defense mechanism by aggressive factors which include; Helicobacter pylori infection Hypersecretion of acid like in gastrinomas Severe physiological stress like severe trauma, major surgery, severe head injury, burn injury etc. Non steroid anti inflammatory drugs (NSAIDS) which inhibit prostaglandin synthesis. Alcohol Cigarette smoking

6. Pathophysiology cont … Helicobacter pylori infection result into inflammation of the mucosal lining, increase acid secretion and allows back flow of acid into the mucosal cell. They secrete urease that allows the to inhabit acidic environment of the stomach. It also results to mucosal metaplasia In hypersecretion state more acid are secreted that the defense system is overwhelmed Nicotine present in tobacco impair mucosal regeneration

7. PHYSIOLOGY OF TREATMENT The physiology of treating peptic ulcer disease lies on the underlying aggressive factor. In general include; Triple therapy for H. pylori associated which include antibiotics and anti acid combinations Anti acid Proton pump inhibitor Stop cigarette smoking and unhealthy drinking.

8. Reference Guyton Hall clinical physiology

9. Thank you