Back To CoursePathophysiology Textbook
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I like watching real-life stories of people who have gone on some vacation or trip only to barely escape alive from the things that Mother Nature throws out at them. If you've watched these shows, you've probably seen how the actors portraying the real-life survivors have all sorts of deep, open sores on their skin and lips from sun exposure, dehydration, or some physical trauma.
Those deep and festering sores don't have to be limited to just the skin; they can occur deep within your body as well, as we'll soon find out.
A more technical term for a deep sore on the body or within the body is an ulcer. A peptic ulcer, also called peptic ulcer disease, is a defect in the gastric or duodenal mucosa extending to the submucosa. The duodenum is the very first part of the intestines that attaches directly to the stomach.
What's important to note is that the peptic ulcer that can occur there or in the stomach isn't just a defect in the superficial-most lining of the stomach and duodenum, the protective mucosa, but is one that also extends down to the deeper, underlying, submucosal layer. This is in contrast to an erosion, which is a defect in the mucosa only.
To picture this a bit better, imagine peeling an orange. If you scrape into an orange and only take off the very top layer of it without exposing the fleshy part, that's an erosion. If you scrape really deeply into it to the point that the juice begins squirting into your eye, that's an ulcer.
In very serious cases, an ulcer may actually penetrate through all the layers of the stomach or duodenum, resulting in something called a perforating ulcer, which is a medical emergency of serious proportions. That's because highly corrosive stomach acid or bacteria from the intestines will leak into your abdomen, causing life-threatening problems. That's why taking care of an ulcer before it's too late is so critical.
The causes of a gastric or duodenal ulcer, a peptic ulcer, are quite varied. The two most common causes for it are a bacterium and a certain class of drugs.
The bacterium is called Helicobacter pylori, or H. pylori for short. This is a Gram-negative bacterium found living below the mucus that protects the stomach from the acid it also produces.
Well, the mucus doesn't just protect the stomach from stomach acid; it also helps to protect H. pylori as H. pylori burrows underneath it. It's kind of like how people in those survivor shows bury themselves under the snow to protect themselves from the much colder air. The same type of deal happens here, but with stomach acid and gooey mucus.
Many times, this bacterium causes no harm to the person, but other times it initiates a process of inflammation of the stomach lining, correctly called gastritis, which eventually leads to ulceration by way of destruction of the stomach tissue. H. pylori doesn't just harm the mucosal protection of the GI tract; it also causes the stomach to actually produce more acid by way of indirectly increasing gastrin secretion, thereby creating even more problems! Gastrin is a hormone produced by G cells of the stomach that promotes acid secretion by the parietal cells of the stomach.
The other major way by which people get peptic ulcers is by using a class of drugs called NSAIDs, or nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen. The more you use these drugs - the more often and in higher quantities - the more likely you are to develop an NSAID-induced peptic ulcer.
The use of some of these NSAIDs alters the production of important compounds called prostaglandins that protect the stomach's lining by increasing the amount of protective mucus that is secreted. NSAIDs also decrease the blood flow to the gastrointestinal tract among many other things. All of these alterations either directly damage the stomach and duodenum or do not allow for their proper repair.
Imagine this: if you cut off the blood supply to your finger by putting a rubber band really tightly over it, your finger would eventually fall off due to the damage caused by not receiving fresh supplies of blood and therefore nutrients. The GI tract also needs a blood supply in order to stay alive and repair itself.
The end result here is this: something causes increased acid production and/or decreased mucosal protection, resulting in a peptic ulcer.
All of this destruction, which results in an ulcer, causes a person a lot of pain and vomiting, sometimes with dark, tarry, stools indicating upper GI bleeding.
These ulcers can be diagnosed by visualizing them through endoscopy, testing for H. pylori, and X-rays if a perforated ulcer is suspected. In chronic cases of ulceration resulting in blood loss, anemia may develop as well.
It is also important that gastric ulcers are biopsied to ensure they are not occurring as a result of stomach cancer.
Treatment of uncomplicated cases of peptic ulcer should be straightforward for you to understand now, given the pathophysiology I have gone over.
We know that increased acid production or decreased mucosal protection are the two main causes of peptic ulcer disease. Therefore, we can neutralize stomach acid by using antacids like Tums, we can decrease acid production by using proton pump inhibitors such as omeprazole, or we can decrease stimulation of the acid-producing parietal cells by using histamine, or H2 blockers such as ranitidine. If you're confused why we use histamine blockers, it's because histamine is a compound that stimulates acid production by the parietal cells.
To deal with the issues of decreasing mucosal protection, we can use a compound called sucralfate, which forms a protective gel that lines the gastrointestinal tract, or we can use a drug called misoprostol, which is a synthetic prostaglandin E1 that increases the secretion of protective mucus.
So there you have it! I hope you never get a peptic ulcer, also called peptic ulcer disease, which is a defect in the gastric or duodenal mucosa extending to the submucosa.
The two most common causes for a peptic ulcer are a bacterium and a certain class of drugs.
The bacterium is called Helicobacter pylori, or H. pylori for short. Many times, this bacterium causes no harm to the person, but other times it initiates a process of inflammation of the stomach lining, correctly called gastritis, which eventually leads to ulceration by way of destruction of the stomach tissue.
The other major way people get peptic ulcers is by using a class of drugs called NSAIDs, or nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen.
Treatment of peptic ulcers involves antacids, substances that stop the secretion of stomach acid, or those that coat and protect the gastrointestinal tract from the acid being produced.
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Back To CoursePathophysiology Textbook
20 chapters | 274 lessons