Study Set Content:
PEPTIC ULCER
• Esophageal • Gastric • Duodenal
MOTILITY DISORDERS
• Constipation • Diarrhea
A group disorder characterized by circumscribed lesions of the mucosa of the upper GI, the lessions occur in the region exposed to gastric juices.
PEPTIC ULCER DISEASE (PUD)
Ulcers develop when the imbalance exists between factors that protect () and factors that promote ()
gastric mucosa, mucosal corrosion.
PATHOPHYSIOLOGY
Excessive gastric and secretion • Decreased mucosal defense against gastric acid
Retrograde movement of gastric contents from the stomach into the esophagus
GASTROESOPHAGEAL REFLUX DISEASE
when reflux leads into inflammation
Reflux (erosive) esophagitis
– typical symptoms but lack evidence of esophageal mucosal injury
Nonerosive reflux disease
develops in the duodenal bulb (first few centimeters of the duodenum), But a few arise between the bulb and the ampulla.
Duodenal ulcers
form most commonly in the antrum or at the antral-fundal function
Gastric ulcers
Less common form.
• Stress ulcers • Zollinger-Ellison Syndrome • Stomal ulcer • Drug-associated ulcers
CAUSATIVE FACTORS:
• Infection with gram negative helicobacter pylori • Use of NSAIDs • Increased HCI secretions • Inadequate mucosal defense against gastric acid • Tumors (rare)
TREAMENT:
• Antimicrobial agents • H2-receptor blockers • Proton pump inhibitor • Prostaglandins • Antimuscarinic agents • Antacids • Mucosal protective agents
PREDISPOSING FACTORS
• Chronic smoking • Ulcerogenic drugs • Alcohol • Emotional and physical stress family history • H. pylori infection
DRUGS FOR PUD ▪ H2-RECEPTOR ANTAGONISTS
✓ Cimetidine ✓ Ranitidine ✓ Famotidine ✓ Nizatidine
The histamine H2-receptor antagonists, act selectively on H2 receptors in the stomach, blood vessels and other sites, but they have no effects on
h2 receptors.
USES:
Peptic ulcers
Acute stress ulcers
Gerd
Adverse effects
Cimetidine: gynecomastia and galactorrhea
INHIBITION OF H’/K’ ATPASE PUMP (PP
INHIBITION OF H’/K’ ATPASE PUMP (PPIs) ✓ Omeprazole ✓ Esomeprazole ✓ Lansoprazole ✓ Pantoprazole ✓ Rabeprazole
INHIBITION OF H’/K’ ATPASE PUMP (PPIs) adverse effects
Osteoporosis, RTI and GIT infections
