Peptic Ulcer Disease

Question 1

Peptic Ulcer Disease - characterised by?

Answer 1

–Erosion of GI mucosa resulting from the digestive action of HCl and pepsin
–Any portion of GI tract that comes in contact with gastric secretions is
susceptible to ulcer development including lower esophagus, stomach, &
duodenum
–Includes gastric and duodenal ulcers

Question 2

Types of pepetic ulcer disease?

Answer 2

Acute
–Superficial erosion
–Minimal inflammation
–Resolves quickly when cause is identified & removed
Chronic
–Muscular wall erosion with formation of fibrous tissue
–Present continuously for many months or intermittently
–4 times more common than acute ulcers

Question 3

Etiology and Pathophysiology

Answer 3

Develop only in presence of acid environment
Excess of gastric acid not necessary for ulcer development
Person with a gastric ulcer has normal to less than normal gastric acidity
compared with person with a duodenal ulcer
Some acid does seem to be essential for a gastric ulcer to occur
Under specific circumstances the mucosal barrier can be broken and HCL
freely enters the mucosa & injury to tissues occurs
This results in cellular destruction & inflammation
Histamine is released
–Vasodilation, ↑ capillary permeability
–Further secretion of acid and pepsin
Agents known to to destroy the mucosal barrier include:
 H. Pylori - causes chronic inflammation making mucosa more vulnerable to
noxious agents
 drugs (aspirin, NSAIDs, corticosteroids) – cause abnormal permeability

Question 4

Gastric Ulcers

Answer 4

Commonly found on lesser curvature in close proximity to antral junction
Less common than duodenal ulcers
Prevalent in women, older adults, persons from lower socioeconomic class
Characterized by a normal to low secretion of gastric acid
Back diffusion of acid is greater (chronic)
The ability of the gastric acid to penetrate the mucosal barrier is more important
than the amount of gastric acid produced
Critical pathologic process is amount of acid able to penetrate mucosal barrier
H. pylori is present in 50% to 70%
H. pylori is thought to be more destructive when noxious agents are used e.g..
drugs or smoking
Drugs can cause acute and chronic gastric ulcers
–Aspirin, corticosteroids, and NSAIDs
–Other known causative factors are:
Chronic alcohol abuse, chronic gastritis
Cigarette smoking is positively linked with gastric ulcers
Ingestion of hot, spicy foods may be a cause but no evidence to support this

Question 5

Duodenal Ulcers

Answer 5

Occur at any age and in anyone
Incidence is high between ages of 35 to 45 years
Affect more men than women
Account for 80% of all peptic ulcers
Associated with ↑ HCl acid secretion
H. pylori is found in 90-95% of patients
–Direct relationship has not been proven
Diseases with ↑ risk of duodenal ulcers -
COPD, cirrhosis of liver, chronic pancreatitis, hyperparathyroidism, chronic renal
failure
Treatments used for these conditions may promote ulcer development
Psychological Stress Ulcers
Acute ulcers that develop following a major physiologic insult such as trauma or
surgery
A form of erosive gastritis

Question 6

Gastric mucosa of body of stomach undergoes a period of transient ischaemia
in association with

Answer 6

–Hypotension
–Severe injury
–Extensive burns
–Complicated surgery

Question 7

Peptic Ulcer Pain

Gastric

Answer 7

Burning or gaseous
Can occur when stomach empty or immediately after food
Located high in epigastrium
Not necessarily relieved by food

Question 8

Duodenal

Answer 8

Burning or cramp-like
Occurs 2-4 hrs after meals
Located in mid-epigastrium
Usually relieved by food or antacids

Question 9

Peptic Ulcer Disease

Complications

Answer 9

3 major complications
–Hemorrhage
–Perforation
–Gastric outlet obstruction
Initially treated conservatively
May require surgery at any time during course of therapy

Question 10

Hemorrhage

Answer 10

Most common complication of peptic ulcer disease
Develops from erosion of
–Granulation tissue found at base of ulcer during healing
–Ulcer through a major blood vessel

Question 11

Perforation

Answer 11

Most lethal complication of peptic ulcer
Commonly seen in large penetrating duodenal ulcers that have not healed and
are located on posterior mucosal wall
Perforated gastric ulcers often located on lesser curvature of stomach