PUD SP 09 sue

PUD SP 09 sue - UpperGIProblems: PepticUlcerDisease...

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Upper GI Problems:  Peptic Ulcer Disease Susan Hampson
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Peptic Ulcer Disease (PUD) Erosion of GI mucosa resulting occurs Ulcer development can occur in Lower esophagus Stomach Duodenum Margin of gastrojejunal anastomosis after surgical  procedures
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PUD: Types Location Duodenal Gastric
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PUD: Types Acute Superficial  erosion Short  duration, resolves  quickly when cause is  identified and removed Minimal inflammation Chronic Muscular wall  erosion  with formation of fibrous  tissue  Long  duration—present  continuously for many  months or intermittently Four times as common as  acute erosion
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PUD: Pathophysiology Acid environment must be present Disruption of mucosal barrier occurs, allows  back flow of pepsin and acid Result is cellular destruction and inflammation When cells destroyed, histamine produced, and  more secretion of acid and pepsin occurs
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PUD: Pathophysiology Compensatory Mechanism Increased blood flow to tissues Hydrogen ions removed Buffers neutralize acid Rate of mucosal cell reproduction occurs Cells receive extra nutrients If buffering and removal of acid is sufficient,  minor or no tissue damage occurs. If blood  flow NOT sufficient, tissue injury occurs.
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PUD: Pathophysiology Impairment in Mucosal Barrier caused by Helicobacter pylori Produces enzyme urease Mediates inflammation making mucosa more vulnerable Aspirin and NSAIDs Inhibit syntheses of prostaglandins Cause abnormal permeability Corticosteroids  Rate of mucosal cell renewal   Protective effects Lipid-soluble cytotoxic drugs Pass through and destroy it   Vagal nerve stimulation   Emotions   in HCl acid
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PUD: Gastric vs. Duodenal GASTRIC Occur in any portion of  stomach Most common—lesser  curvature in close to antral  junction Western countries—less  common than duodenal  ulcers Prevalent in women, older  adults Peak incidence >50 years  of age DUODENAL Occur at any age and in  anyone  Between ages of 35 to  45 years  Account for ~80% of all  peptic ulcers Familial tendency Person with blood group O   risk
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PUD: Gastric vs. Duodenal GASTRIC Associated with  normal to  low secretion  of gastric  acid 60% to 80% present with  H. pylori H. pylori —more destructive  when drugs or  smoking  involved DUODENAL Associated with  increased  HCl acid secretion H. pylori  is found in 90% to  95% of patients Not all individuals with  H.  pylori  develop ulcers
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PUD: Gastric vs. Duodenal GASTRIC Causes Drugs Aspirin, NSAIDs,  corticosteroids
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PUD SP 09 sue - UpperGIProblems: PepticUlcerDisease...

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