Peptic Ulcer [Written Summary] PDF
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- Blood supply & venous drainage of stomach
- Nerve supply of stomach
- Histology of the stomach
- Surgical Physiology >>> Gastric motility, Gastric secretion,
- Phases of gastric secretion>>> 1/ Cephalic (neural) phase , 2/ Gastric Phase , 3/ Intestinal Phase
- Pathology of Peptic Ulcer
- Special Forms of Peptic Ulceration: 1/ Stress ulcer , 2/ Curling’s ulcer , 3/ Cushing’s ulcer
- Sites: 1) Duodenum, 2) Stomach , 3) Esophagus , 4) Jejunum, 5) Meikle’s diverticulum
- Etiology >> 1/ Acute peptic ulcer 2/ Chronic peptic ulcer
- and more…….
G.U in Post. wall → erode to pancreas
G.U in Ant. wall → erode to liver
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Sample of the summary::
( 17 pages )
Blood supply & venous drainage of stomach:
Nerve supply of stomach: 1/ Sympathetic
– ant.vagal trunk → hepatic branch → descend along lesser c urvature &
supply ant. wall of stomach
– post.vagal trunk → coelic branch
→ supply back wall of stomach
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Ant & Post vagus hepatic branch celiac b. Stomach liver & gall bladder -pancreas
1/ Columnar epith :
Lines the whole stomach
2/ Cardiac gland:
Secrete mucous and electrolytes
Occupy a small ring around the oesophagogastric junction
3/ Oxyntic glands:
Occupy the fundus and body of stomach
a- parietal cells:
produce H+ & intrinsic factor
it is double its # in duodenal ulcer & 4х in Zollinger Ellison syndrome its # is ↓ in gastric ulcer b- peptic (chief) cells: in the fundus &
4/ Pyloric glands: In the antrum
Secrete mucous & electrolytes
In the antrum
Its # increase only in duodenal ulcer
1/ Gastric motility:
Body & fundus act as a reservoir for food.
Antrum acts as a mill, mix & grind the food & expel it to the duodenum.
Gastric motility is controlled by intrinsic neural plexus which are regulated by the extrinsic nerve supply (vagus) Truncal vagotomy affects & reduces gastric motility. Also, sympathetic n. inhibit gastric motility.
2/ Gastric secretion:
Mucus is secreted in all regions of stomach & protects surface
epith. against acid and pepsin.
Acid & pepsin secretion is regulated by a neurocrine, endocrine
& paracrine factors.
Neurocrine: Ach from vagus
Endocrine: Gastrin from antrum
Paracrine: Histamine from cells near to parietal or peptic cells Parietal (w secrete H+) & pepsin (w secrete pepsin) cells has
specific receptor for each of the 3 stimulants.
The action of each stimulant is potentiated by the other two. Eg;
Gastrin & Ach release histamine from mucosal stares.
Ach stimulate secretion by inhibit the release of somatostatin. In truncal vagotomy not only Ach stimulation is affected, but also gastrin & histamine efficacy is reduced.
Phases of gastric secretion: 1/ Cephalic (neural) phase:
Sight, smell, taste or though stimulate vagal center Vagus → stimulate pept ic & parietal cells (direct) → stimulate gastrin release from antrum (indirect)
2/ Gastric Phase:
Distention of gastric antrum & products of protein digestion
stimulate gastrin release from antral mucosa.
3/ Intestinal Phase:
Food in small bowel release enteroxyntin (duodenal gastrin)
that increases acid release.
Due to imbalance between gastric acid – pepsin secretion and the ability of the GI mucosa to define against them. This imbalance occurs due to:
a. Hyper secretion of acid and pepsin. (D.U) b. Defect in mucosal defense. (G.U) c. H.pylori infection.
Special Forms of Peptic Ulceration: 1/ Stress ulcer:
Occur after major surgery, trauma or sever illness.
Multiple small superficial ulcers in the stomach or duodenum.
2/ Curling ’s ulcer:
In patient with sever burns. In the duodenum.
3/ Cushing’s ulcer:
In patient with neuro-surgical illness or head injury. In both stomach or duodenum.
o The 1 st part of the duodenum is the commonest. o If it is in the Ant. surfac e → perforation.
o If it is in the Post. surface → He by erosion of arteries.
o Type 1 (1ry GU): often in the lesser curvature. o Type 2: same as type 1 plus a D.U.
o Type 3: in pyloric channel or prepyloric area.
o At the lower end.
o Due to reflux of acid and pepsin from the stomach.
o Zollinger-Ellison syndrome. o After gastro-jejunostomy.
5) Meikle’s diverticulum:
o Due to the presence of ectopic gastric mucosa.
G.U in Post. wall → erode to pancreas G.U in Ant. wall → ero de to liver
1/ Acute peptic ulcer:
May be without apparent cause.
Or associated with ingestion of alcohol, NSAID or steroidal
Also it can be associated with stress ulcer, curling’s ulcer or
2/ Chronic peptic ulcer:
I. Genetic & blood group
Blood group O 3x likely to get D.U α¹ – antitrypsine deficiency
II. Neurogenic therapy
Vagal stimulation → hyper secretion & hyper motility ← Stress & anxiety +→ vagus
III. Accessory causes (factors)
Excessive smoking Vitamine deficiency