Peptic ulcer
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Peptic ulcer
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| Laboratory value | Result |
| CBC, Serum | |
| Hemoglobin | 10.1 g/dL |
| Hematocrit | 30% |
| Leukocyte count | 14,000 /mm3 |
| Platelet count | 160,000/mm3 |
| Serum | |
| Sodium | 132 mEq/L |
| Potassium | 4.2 mEq/L |
| Chloride | 95 mEq/L |
| BUN | 67 mg/dL |
| Creatinine | 2.6 mg/dL |
| Albumin | 3.7 g/dL |
| AST | 60 U/L |
| ALT | 30 U/L |
| Alkaline Phosphatase | 110 U/L |
| Bilirubin, total | .7 mg/dL |
| Lipase | 100 U/L |
Memory Anchors and Partner Content
External References
First Aid
2024
2023
2022
2021
Bleeding
peptic ulcer disease p. 387
Burns
acute gastric ulcer p. 732
Gastric ulcers p. 387
NSAID toxicity p. 495
Nonsteroidal anti-inflammatory drugs (NSAIDs) p. 495
gastric ulcers from p. 387
peptic ulcer disease and p. 387
Peptic ulcer disease p. 387
associations p. 725
glycopyrrolate for p. 240
H2 blockers for p. 405
Helicobacter pylori p. , 144
misoprostol for p. 406
proton pump inhibitors for p. 405
Zollinger-Ellison syndrome p. 357
Perforation (GI) p. 387
duodenal ulcer p. 371
Weight loss
gastric ulcers p. 387
Transcript
Content Reviewers
Peptic refers to the stomach, and an ulcer is a sore or break in a membrane, so peptic ulcer disease describes having one or more sores in the stomach - called gastric ulcers - or duodenum - called duodenal ulcers- which are actually more common.
Normally, the inner wall of the entire gastrointestinal tract is lined with mucosa, which has three cell layers.
The innermost layer is the epithelial layer and it absorbs and secretes mucus and digestive enzymes.
The middle layer is the lamina propria and it contains blood and lymph vessels.
Then there’s the outermost layer which is the muscularis mucosa, and it’s a layer of smooth muscle that contracts and helps break down food.
In the stomach, there are four regions - the cardia, the fundus, the body, and the antrum.
So the epithelial layer in different parts of the stomach contains different proportions of gastric glands which secrete various substances.
Having said that, the cardia contains mostly foveolar cells that secrete mucus which is a mix of water and glycoproteins.
The fundus and the body have mostly parietal cells that secrete hydrochloric acid and chief cells that secrete pepsinogen, an enzyme that digests protein.
Finally, the antrum has mostly G cells that secrete gastrin in response to food entering the stomach. These G cells are also found in the duodenum and the pancreas, which is an accessory organ of the gastrointestinal tract.
Gastrin stimulates the parietal cells to secrete hydrochloric acid, and more broadly stimulates the growth of glands throughout the stomach.
In addition, the duodenum contains Brunner glands which secrete mucus rich in bicarbonate ions.
In fact, with all of the digestive enzymes and hydrochloric acid floating around, the stomach and duodenal mucosa would get digested if not for the mucus coating the walls and bicarbonate ions secreted by the duodenum which neutralizes the acid.
In addition, the blood flowing to the stomach and duodenum brings in even more bicarbonate which helps neutralize the hydrochloric acid.
Summary
A peptic ulcer is an erosion or a break in gastric or/and duodenal mucosa. The most common causes of peptic ulcers are infection with a bacterium called Helicobacter pylori (H. pylori) and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. Symptoms of a peptic ulcer include abdominal pain, usually felt in the upper middle or upper left part of the abdomen, bloating, vomiting, nausea, and loss of appetite. In severe cases, a peptic ulcer can cause bleeding or a perforation in the mucosa of the stomach or duodenum. Treatment includes a combination of medications called triple therapy to kill the H. pylori bacteria and reduce acid production in the stomach. Surgery is the last optional treatment to repair the ulcer if drugs are unsuccessful.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "Peptic ulcer disease" The Lancet (2017)
- "The ulcer sleuths: The search for the cause of peptic ulcers" Journal of Gastroenterology and Hepatology (2011)
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