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Question 1

What is the etiology of peptic ulcers?

Answer 1

Two major factors: Exposure to gastric acid and pepsin; Helicobacter pylori infection. Other contributing factors include:
* stress (acute ulcers)
* genetics
* diet
* NSAIDs
* smoking
* alcohol
* bile reflux
* gastritis

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Question 2

Specific etiological factors for duodenal ulcers?

Answer 2

High acid-pepsin secretion, rapid gastric emptying, H. pylori infection (95-100%)

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Question 3

Specific etiological factors for gastric ulcers?

Answer 3

Impaired gastric mucosal defenses, H. pylori infection (75-80%), gastritis, bile reflux, cigarette smoke. Acid levels may be normal or high

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Question 4

Pathogenesis of duodenal ulcers?

Answer 4

High acid-pepsin secretion overwhelms defenses; rapid gastric emptying exposes duodenum; H. pylori disrupts mucus barrier

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Question 5

Pathogenesis of gastric ulcers?

Answer 5

Impaired gastric mucosal defenses (reduced mucus production/quality); H. pylori infection weakens barrier; other factors (gastritis, bile reflux, smoking) contribute

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Question 6

Pathogenesis of acute stress ulcers?

Answer 6

Ischemic-hypoxic injury to mucosal cells; depletion of gastric mucus barrier; increased acid secretion (in some cases). Mechanism not fully understood

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Question 7

Gross pathological changes in acute stress ulcers?

Answer 7

Multiple (often >3), small, shallow ulcers; commonly located anywhere in the stomach, more common in the duodenum

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Question 8

Microscopic changes in acute stress ulcers?

Answer 8

Shallow, do not invade muscular layer; inflammatory reaction; complete re-epithelialization without scarring (usually)

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Question 9

Gross pathological changes in chronic ulcers (gastric and duodenal)?

Answer 9

Usually solitary; round to oval; 1-2.5 cm diameter; may penetrate deep into the muscular layer

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Question 10

Microscopic changes in chronic ulcers?

Answer 10

Not provided in the text

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