peptic ulcer disease from Medicine point of view

1. PEPTIC ULCER DISEASE
Dr. UJJWAL DEEP
JR1 (DNB INTERNAL MEDICINE)

2. ANATOMY

5. GASTRODUODENAL MUCOSAL DEFENSE
 MUCOSAL DEFENSE
 3 layer barrier , composed of preepithelial, epithelial and subepithelial
 first line of defense is mucus-bicarbonate-phospholipid layer which is a
physiochemical barrier to multiple molecules
 SURFACE EPITHELIAL CELLS
 Mucus production
 Epithelial cell ionic transporter that maintains pH
 Bicarbonate production
 Intracellular tight junction

6.  PROSTAGLANDINS
 Central role in gastric epithelial defense repair
 Regulates release of mucosal bicarbonates and mucus
 Inhibits parietal cell secretion
 Maintains mucosal blood flow and epithelial cell restitution

7. PHYSIOLOGY OF GASTRIC SECRETION
 Hydrochloric acid and pepsinogen are two principal gastric secreatory product capable
of mucosal Injury.
 Gastric acid secreation stimulated in three phases:
 Cephalic phase – sight , smell, taste of food stimulates secreation via
vagus nerve
 Gastric phase – activated once food enters stomach
food stimulates G cells release gastrin activates parietal
cells via direct and indirect mechanism .
 Intestinal phase- initiated due to luminal distension when food enters inters
intestine

9.  GI hormones
SOMATOSTATIN- inhibit acid production
ANP,CCK,IL11,OBESTATIN,SECRETIN- counterbalancing acid secreation
GHRELIN- may increase acid secreation throught histamine release