Peptic Ulcer Disease

Summary:

Peptic ulcer disease is a condition caused by a break in the continuity of the gastric or duodenal mucosal layer that extends to the submucosa or deeper. It can be caused by factors such as H. Pylori, NSAIDs, hyperparathyroidism, Zollinger-Ellison syndrome, smoking, Cushing’s ulcer, SSRIs, burns, chemotherapy, and alcohol. The role of NSAIDs in PUD establishment is that they block COX1 and COX2, preventing the release of prostaglandins that stimulate the production of the mucus lining. H. Pylori is a bacterium that is ingested in the stomach and causes PUD by releasing mucinous, urease, vacA, and cagA. PUD can be diagnosed through several investigations such as FBC, endoscopy, biopsy, stool culture, urea breath test, barium x-ray, clo test, serology, and scintigraphy w/ contrast. Triple therapy is used for the medical treatment of PUD, and surgical management may be required for some cases. Complications of PUD include perforation, bleeding, gastric cancer, and GOO. Proper management of PUD includes admission, primary survey, taking samples for relevant labs, starting IV fluid resuscitation, passing NG tube and urinary catheter, transfusing blood if necessary, administering high dose IV PPi, and preparing for surgery.

Excerpt:

Peptic Ulcer Disease

An ulcer is a break in the continuity of the epithelial layer.
A peptic ulcer is caused by pepsin, produced by the chief cells. Peptic ulcer disease is a defect in the gastric or duodenal mucosal layer and extends to the submucosa or deeper.

Etiology:
• H.Pylori
• NSAIDS
• Hyperparathyroidism
• Zollinger-Ellison syndrome/gastrinoma
• Smoking
• Cushing’s ulcer
• SSRIs: only aggravate bleeding in preexisting pud by inhibiting platelets, preventing the blood from clotting.
• Burns
• Chemotherapy

*hcl release is stimulated by gastrin, histamine and Acetylcholine.

H.Pylori
– It’s helical in structure and produces various virulent factors, e.g., vacA and cagA.
– It’s Gram-negative with 4-6 flagella, i.e. highly motile. It’s capable of producing various enzymes like Urease, Mucinase.