Gastritis n PUD
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Transcript of Gastritis n PUD
8/4/2019 Gastritis n PUD
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PATHOPHYSIOLOGY OF
GASTRITIS AND PEPTICULCER
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Pathophysiology of Gastritis
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Gastritis Can be classified as:
Acute
Chronic
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Acute Gastritis
Erosive Medications
Alcohol
Cocaine
Stress
Radiation
Bile reflux Ischemia
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Acute Gastritis
Bacterial Helicobacter pylori
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Chronic Gastritis
H pyloriassociated chronic gastritis
Infectious granulomatous gastritis
Gastritis in patients who are immunosuppressed
Autoimmune gastritis
Chronic reactive chemical gastropathy Chronic noninfectious granulomatous gastritis
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Pathophysiology of Peptic Ulcer
Disease (PUD)
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Definition:
A peptic ulcer, sometimes called a stomach ulcer, is a
sore that forms in the lining of the stomach or of the
duodenum Deeper than just mucosa
Gastric ulcer
Duodenal ulcer
Together, ulcers of the stomach and duodenum
are referred to as peptic ulcers.
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Anatomy of stomach and duodenum
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Anatomy of stomach and duodenum
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� Mucous cells in the gastric
pits secrete mucus
parietal cells secrete
hydrochloric acid
G cells, which are present
predominantly only in the
antrum of the stomach,
secrete gastrin
chief cells secrete
pepsinogen
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Production of acid in stomach
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DEFENSE SYSTEM OF STOMACH AND DUODENUM
The mucous layer, which coats the stomach and duodenum,
forms the first line of defense.
Bicarbonate, which the mucous layer secretes, neutralizes the
digestive acids.
Hormone-like substances called prostaglandins help keep the
blood vessels in the stomach dilated, ensuring good blood flow
and protecting against injury. (Prostaglandins are also believed
to stimulate bicarbonate and mucus production.)
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Normal
Increased attackHyperacidity
Weak defenseHelicobacter pyloriStress, smoking, drugs
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GENERAL SYMPTOMS OF PEPTIC ULCER
� Pain in the upper abdomen below the sternum(breastbone) that comes and goes.
� It may occur most before meal or when you are hungry
� Other symptoms:
Bloating, dyspepsia, nausea, vomiting, poor appetite,
weight loss, burping (belching)
� Complication:
Bleeding from ulcer
Perforation
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COMPLICATIONS: Bleeding
Fibrosis, Stricture obstruction pyloric
stenosis.
Perforation Peritonitis- emergency.
Gastric carcinoma.
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Etiology:
Helicobacter pylori infection(90%).
Drugs - anti-inflammatory (NSAIDs) & Corticosteroids.
Hyperacidity - eg. Zollinger Ellison syndrome.
Cigarette smoking, Alcohol
Stress
Coffee
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MORPHOLOGY
Spiral shaped and multipollar
flagella
H pylori is a gramnegative rod
about 3.5 micrometers long and
0.6 micrometers wide that
thrives at 37°C (98.6°F) in
a neutral medium.
Corckscrew motivation
Micreaerophile
Producing Urease
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Helicobacter pylori:
Most common infection in the world
H.pylori related disorders:
Chronic gastritis 90% Peptic ulcer disease 95-100%
Gastric carcinoma
Reflux Oesophagitis (GERD)
Non ulcer dyspepsia
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PATHOGENESIS
Optimum pH 6-7
Lumen of stomach is with pH of 1-2
Live in deeper parts under lumen where pH is 7.4
Urease reduce the acidity of stomach
Protease Mucous break down.
Cytotoxine (vacoulating gene{Vac A},
Cytotoxin-associated gene{Cag A})
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Helicoba
cter pylori
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Complications of Peptic Ulcers
Haemorrhage
Perforation
Pyloric Stenosis
Development of malignant tumor