Slides I GI.pptx - GASTROINTESTINAL AND ANTIEMETIC DRUGS DRUGS FOR PEPTIC ULCER(PUD AND GASTROESOPHAGEAL REFLUX DISEASE(GERD PEPTIC ULCER DISEASE

Slides I GI.pptx - GASTROINTESTINAL AND ANTIEMETIC DRUGS...

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GASTROINTESTINAL AND ANTIEMETIC DRUGS
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DRUGS FOR PEPTIC ULCER (PUD) AND GASTROESOPHAGEAL REFLUX DISEASE (GERD)
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PEPTIC ULCER DISEASEDefinitionGroup of upper GI disorders Degrees of erosion of the gut wallSevere erosion can be complicated by hemorrhage and perforationCauseImbalance between mucosal and aggressive factors
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PATHOGENESIS OF PEPTIC ULCERSDefensive factorsMucusSecreted cells of the GI mucosaForms a barrier to protect underlying cells from acid and pepsinBicarbonateSecreted by epithelial cells of stomach and duodenumMost remains trapped in the mucus layer to neutralize hydrogen ions that penetrate the mucusBlood flowPoor blood flow can lead to ischemia, cell injury, and vulnerability to attackProstaglandinsStimulate the secretion of mucus and bicarbonate
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Fig. 78–1. The relationship of mucosal defenses and aggressive factors to health and peptic ulcer disease. When aggressive factors outweigh mucosal defenses, gastritis and peptic ulcers result.
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PATHOGENESIS OF PEPTIC ULCERSAggressive factorsHelicobacter pylori,also known as H. pyloriGram-negative bacillus that can colonize in the stomach and duodenumLives between epithelial cells and the mucus barrierEscapes destruction by acidCan remain in GI tract for decadesHalf of the world infected, but most people do not develop symptomatic peptic ulcer disease (PUD)
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PATHOGENESIS OF PEPTIC ULCERSAggressive factorsHelicobacter pylori,also known as H. pylori (cont’d)60%–70% of patients with PUD have H. pyloriinfectionH. pylorimay also promote gastric cancerDuodenal ulcers are much more common among people with H. pyloriinfection than among people who are not infectedEradication of the bacterium promotes healing of the PUD and minimized recurrence of PUD
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PATHOGENESIS OF PEPTIC ULCERSAggressive factorsNonsteroidal anti-inflammatory drugs (NSAIDs)Inhibit the biosynthesis of prostaglandinsDecrease blood flow, mucus, and bicarbonateGastric acidCauses ulcers by directly injuring cells of the GI mucosa and indirectly by activating pepsinIncreased acid alone does not increase ulcers but is a definite factor in PUDPepsin Proteolytic enzyme in gastric juiceSmokingDelays ulcer healing and increases risk for recurrence
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PATHOGENESIS OF PEPTIC ULCERSSummary of ulcer developmentMost common cause Infection with H. pylori(HP) is the most common cause of gastric and duodenal ulcersAdditional factors must be involved: 50% harbor HP, but only 10% develop PUDSecond most common causeNSAIDs
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PEPTIC ULCER DISEASE (PUD)Duodenal ulcers Occurs in 30-55 yrs of ageMore common in malesUlcers are five times more common in the duodenum than in the stomach.
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