Pharm Test 2 Gi

Front 1

Peptic Ulcer Disease (PUD)

Back 1

Erosion of the lower curvature of the stomach & upper part of the duodenum by exposure to acid and pepsin which can lead to periferation

Front 2

General Cause of PUD

Back 2

Helicobacter pylori (H. pylori)

Front 3

PROMOTING FACTORS
OF PUD

Back 3

* H. pylori
* NSAIDS
* Acid
* Pepsin
* Smoking

Front 4

DEFENSIVE FACTORS
OF PUD

Back 4

* Mucus
* Bicarbonate
* Blood flow
* prostaglandins

Front 5

DEFENSIVE FACTORS
OF PUD - Mucus

Back 5

Continuously secreted by cells in the GI mucosa. Protects underlying cells from attack by acid and pepsin.

Front 6

DEFENSIVE FACTORS
OF PUD - Bicarbonate

Back 6

* Secreted by epithelial cells of the stomach and duodenum. Neutralizes hydrogen (H+) ions.
* Also produced by the pancreas and secreted by the duodenum to neutralize any acid delivered from the stomach

Front 7

DEFENSIVE FACTORS
OF PUD - Blood flow

Back 7

* Need blood flow to the maintain submucosa integrity
* Local ischemia (dec. supply of oxygenated blood to specific area of body) can lead to cell injury allowing pepsin and acid to attack

Front 8

DEFENSIVE FACTORS
OF PUD - Prostaglandins

Back 8

* Stimulates secretion of mucus and bicarbonate and promotes vasodilation to maintain mucosal blood flow.
* Also suppresses secretion of gastric acid

Front 9

Aggressive Factors of PUD - Helicobacter pylori

Back 9

* Gram negative bacteria that colonizes in the stomach & duodenum.
* Resides between the epithelial cells and mucus barrier & is NOT destroyed by acid or pepsin.
* Produces urease that forms CO2 & ammonia

Front 10

Aggressive Factors of PUD - NSAIDS

Back 10

Including aspirin, inhibits biosynthesis of prostaglandins. Which dec. blood flow, suppresses secretion of mucus and bicarbonate & promotes secretion of gastric acid

Front 11

Aggressive Factors of PUD - Gastric Acid

Back 11

* Acids directly injures cells by activating pepsin
* Zollinger-Ellison syndrome – tumor that secrets gastrin which stimulates gastric acid.

Front 12

Aggressive Factors of PUD - Pepsin

Back 12

* A proteolytic enzyme present in gastric juice & promotes ulcers by breaking down protein in the gut wall.
* Pepsin is pH dependant, higher the pH the less pepsin
* Goal is to raise pH > 5 to avoid activating pepsin.

Front 13

Aggressive Factors of PUD - Smoking

Back 13

Reduces secretion of bicarbonate & accelerates gastric emptying which delivers more acid to the duodenum