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52 Cards in this Set

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peptic ulcer dz (pud)
circumscribed lesions of the mucosa of the upper gi tract particularly the stomach and duodenum

lesions occur in regions exposed to gastric juices
gastroexophageal reflux dz
gerd
retrograde movmt of gastric contents fr the stomach into the esophagus
reflux -> gerd -> inflam in exophagus =
reflux erosive esophagitis
nerd
nonerosive reflux dz
dyspepsia
persistent or recurrent abd pain or abd discomfort centered in the upper abdomen
duodenal ulcer
develop in the duodenal bulb
gastric ulcers
antrum or at the antral-fundal jxn
less common forms of pud
stress ulcers
zollinger ellison syndrome
stomal ulcers
drug-assoc ulcers
stress ulcers
result fr serious trauma or illnes

major burns
most common site of stress ulcer formation
proximal portion of the stomach
zollinger ellison syn
severe form of pud in w/c intractable ulcers are accompanied by extreme gastric hyperacidity and at least 1 gastrinoma
gastrinoma
non beta islet cell tumor of the pancreas or another site
stomal ulcers (marginal ulcers)
arise at anastomosis or immediately distal to it in the small intestine in pts who have undergone ulcer surgery
drug assoc ulders
chronically ingest subs that damage gastric mucosa-> nsaids
reflux esophagitis
presence of recurrent sx (hrtburn) or altered epithelial morphology visualized radiologically, endoscopically or histologically
heartburn
substernal burning or regurgitation that may radiate to the neck
sx of hrtburn
belching
water brach
chest pain
asthma
chronic cough
hoarseness
laryngitis
endoscopic evaluation
detected Barrett's esophagus in 6% of pt's with frequent hrtburn
barrett's esophagus
premalignant condition that may lead to adenocarcinoma of the exophagus or esophagogastric jxn
most common disorder of the upper gi tract
pud
ulcers penetrate
muscularis propria -> serosa -> pancreas
ulcer base
fibrous tissue
granulation tissue
necrotic debris
ulcer healing
scar forms as epithelium from the edges covers the ulcer surface
benign
duodenal ulcer
malignant
gastric ulcers
h pylori (camphylobacter pylori)
g - microaerophilic, spiral bacterium with multiple flagella that lives and infects the gastric mucosa
bacterium
able to survive in the acidic gastric environment by its ability to produce urease
urease
hydrolyzes urea into ammonia
ammonia
neutralizes gastric hcl creating a neutral cloud surrounding the organism
h pylori + individuals develop
duodenal ulcers
eradication of h pylori
cure peptic ulcers and reduce ulcer recurrence

eliminate the need for maintenance therapy in many ulcer pt's
bld type O
above normal incidence of duodenal ulcers
cigarette smoking
delays ulcer healing and inc the risk and rapidity of relapse after ulcer heals

accelerates the emptying of stomach acid into the duodenum
nicotine
dec biliary and pancreatic bicarbonate secretion
promote gastric ulcer formation
asa
indomethacin
nsaids
prostaglandins
subs w/ cytoprotective eff on mucosa
alcohol
known mucosal irritant causes marked irritation of gastric mucosa
coffee
contain peptides that stimulate release of gastrin
gastrin
hormone that triggers flow of gastric juice
assoc disorders in pud
hyperparathyroidism
emphysema
ra
alcoholic cirrhosis
degeneration of the pylorus permits bile reflux in stomach
creasting an environment that favors ulcer formation
imbalance between
- protect gastric mucosa

- promote mucosal corrosion

equals ULCER
protective factors
normally the mucosa secretes a thick mucus that serves as a barrier between luminal acid and epithelial cell
barrier
slows the inwards movement of h ion and allows their neutralization by bicarb ions in fluids secreted by stomach and duodenum
alkaline and neutral pancreative biliary juice
help buffer acid entering the duodenum from the stomach
intact mucosal barrier
prevents back diffusion of gastric acids into mucosal cells

it also has the capacity to stimulate local bld flow
bld flow
brings nutrients and other subs to the area and removes toxic subs (h ions)
mucosal integrity
promotes cell growth and repair after local trauma
inability of gastric mucosa to resist corrosion by irritants
pud
corrosion irritants
pepsin
hcl
other gastric secretions
necessary for ulcer development
exposure to gastric acid
pepsin
disrupted mucosal barrier integrity
allows gastric acid to diffuse from the lumen back into mucosal cells where they cause injury