,Peptic ulcer disease (PUD) - Answer: refers to a group of upper gastrointestinal (GI) disorders
characterized by varying degrees of erosion of the esophagus, stomach, and small intestine. Severe
ulcers can be complicated by hemorrhage and perforation.
can develop in any region exposed to acid and pepsin, ulceration is most common in the lesser
curvature of the stomach and the duodenum.
Most cases of PUD are caused by - Answer: Helicobacter pylori and eradication of this bacterium not
only promotes healing but also greatly reduces the chance of recurrence.
develop when there is an imbalance between mucosal defensive factors and aggressive factors.
The major defensive factors are mucus and bicarbonate. The major aggressive factors are H. pylori,
nonsteroidal antiinflammatory drugs.
Mucus Defense factor - Answer: is secreted continuously by cells of the GI mucosa, forming a barrier
that protects underlying cells from attack by acid and pepsin
Bicarbonate defense factor - Answer: is secreted by epithelial cells of the stomach and duodenum. It
serves to neutralize any hydrogen ions that penetrate the mucus.
produced by the pancreas is secreted into the lumen of the duodenum, where it neutralizes acid
delivered from the stomach
Adequate blood flow (GI) - Answer: to cells of the GI mucosa is essential for maintaining mucosal
integrity.
Prostaglandins Defense mechanism - Answer: stimulate secretion of mucus and bicarbonate, and they
promote vasodilation, which helps maintain submucosal blood flow.
They provide additional protection by suppressing secretion of gastric acid.
H. pylori - Answer: is a gram-negative bacillus that can colonize the stomach and duodenum. By residing
in the space between epithelial cells and the mucus barrier that protects these cells, the bacterium
manages to escape destruction by acid and pepsin.
can remain in the GI tract for decades.
, NSAIDs affect on GI - Answer: are the underlying cause of many gastric ulcers and some duodenal
ulcers.
inhibit the biosynthesis of prostaglandins. By doing so they can decrease submucosal blood flow,
suppress secretion of mucus and bicarbonate, and promote secretion of gastric acid.
also irritate the gastric mucosa directly.
Gastric acid affect on GI - Answer: is an absolute requirement for peptic ulcer generation: in the
absence of acid, no ulcer will form.
causes ulcers directly by injuring cells of the GI mucosa and indirectly by activating pepsin, a proteolytic
enzyme.
hypersecretion by itself is insufficient to cause ulcers
Zollinger-Ellison syndrome - Answer: is the primary disorder in which hypersecretion of acid alone
causes ulcers. The syndrome is caused by a tumor that secretes gastrin, a hormone that stimulates
gastric acid production. The amount of acid produced is so large that it overwhelms mucosal defenses.
Pepsin is a proteolytic enzyme present in gastric juice. Like gastric acid, pepsin can injure unprotected
cells of the gastric and duodenal mucosa
PUD goals of drug therapy - Answer: (1) alleviate symptoms, (2) promote healing, (3) prevent
complications (hemorrhage, perforation, and obstruction), and (4) prevent recurrence. Except for
antibiotics, the drugs employed do not alter the disease process. they simply create conditions
conducive to healing. Because nonantibiotic therapies do not cure ulcers, the relapse rate after their
discontinuation is high. the relapse rate after antibiotic therapy is low.
Drug classes used to treat PUD - Answer: antibiotics, antisecretory agents (PPIs and H2 receptor
antagonists); mucosal protectants, antisecretory agents that enhance mucosal defenses and antacids
Drugs act in three basic ways to promote ulcer healing. - Answer: they can (1) eradicate H. pylori
(antibiotics), (2) reduce gastric acidity (antisecretory agents, misoprostol, and antacids), and (3) enhance
mucosal defenses (sucralfate and misoprostol).
risk factors for ulcer development - Answer: older than 60 years, history of ulcers, high-dose NSAID
therapy
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