The damaging forces include the H.pylori infection, secretion of gastric acid and pepsin, and the superimposed injury from environmental or immunologic agents. The mucosal defense mechanism includes bicarbonate secretion, mucous secretion, tight adherence between epithelial cells to prevent acid leakage, good blood supply, and the renewal of the damaged epithelial cells. The H-pylori’s ability to induce inflammation, stimulates the release of cytokines and other mediators of inflammation to contribute to the mucosal damage. The infection in the antrum of the stomach will lead to hypergastrinemia and an increased acid production. The increase in the acid in the duodenum will impair duodenal bicarbonate production, thus reducing the luminal pH in the duodenum. This promotes the development of gastric metaplasia, resulting in the colonization of organisms in these area, leading to the development of duodenal ulcers (Grossman & Porth, …show more content…
The pain with the peptic ulcer is usually located near the midline in the epigastrium near the xiphoid and may radiate to the back or shoulders. The pain occurs in periodicity,which tends to recur at intervals of weeks or months and is relieved by food or antacids. The other major complications of peptic ulcer disease are hemorrhage, perforation and penetration, and gastric outlet obstruction. An erosion of an ulcer into an artery or vein can cause hemorrhage. Acute post hemorrhagic anemia is another complication with the peptic ulcer disease. The evidence of bleeding in peptic ulcer is seen as hematemesis (blood stained vomitus), and as melena (black tarry stools). The episode of acute hemorrhage in peptic ulcer is evidenced by dizziness; thirst; cool, moist skin; the desire to defecate; and the passage of loose, tarry, or red stools, and coffee-ground emesis. The patient can even develop hypovolemic shock in the severe hemorrhagic situations (Grossman & Porth, 2014). The perforation occurs in the peptic ulcer when the ulcer erodes through the walls of the stomach or duodenum. The perforation will result in the GI contents to enter peritoneum, causing peritonitis. The patient might experience pain radiating to the back, severe night distress, and inadequate pain relief from