Peptic ulcer

Pathophysiology of peptic ulcer

• Imbalance in acid production:mucus layer protection
• Key concepts - role ofP cells, proton pump, G cells, gastrin, PG, stomach vascular supply, ECL cells, histamine

Causes (predisposing, precipitating, perpetuating)

• NSAIDS, aspirin, clopidogrel (PG synthesis)
• Z-E syndrome (ectopic gastric production)
• H. Pylori (mucosal barrier, acid production)
• Smoking (perpetuating cause, multiple mechs)

Complications

• Bleeding / Anaemia
• Inflammation / Scarring (stricture/obstruction)
• Perforation / Peritonitis / Sepsis

Treatments

• Antacid (direct neutralisation)
• PPI (H+/K+ pump)
• H2 antagonists (histamine)
• Misoprostol (PG synthesis)
• Sucralfate (aid mucosal barrier0