{"id":5378,"date":"2025-12-08T21:28:45","date_gmt":"2025-12-09T02:28:45","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/?post_type=chapter&#038;p=5378"},"modified":"2026-01-12T18:38:38","modified_gmt":"2026-01-12T23:38:38","slug":"10p12-peptic-ulcers","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/chapter\/10p12-peptic-ulcers\/","title":{"raw":"10p12  Peptic Ulcers","rendered":"10p12  Peptic Ulcers"},"content":{"raw":"<strong>Peptic Ulcers: Causes, Pathophysiology, and Complications<\/strong>\r\n<h1><strong>Main Cause<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Helicobacter pylori<\/strong>\u00a0bacteria:\r\n<ul>\r\n \t<li>Causes approximately\u00a0<strong>10 million Canadians<\/strong>\u00a0to be infected.<\/li>\r\n \t<li>Contributes to\u00a0<strong>gastric<\/strong>\u00a0and\u00a0<strong>duodenal ulcers<\/strong>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Other contributing factors:\r\n<ul>\r\n \t<li><strong>NSAIDs<\/strong>\u00a0(e.g., aspirin) and\u00a0<strong>aspirin<\/strong>\u00a0use.<\/li>\r\n \t<li><strong>Excessive alcohol and caffeine<\/strong>.<\/li>\r\n \t<li><strong>Stress<\/strong>\u00a0and\u00a0<strong>smoking<\/strong>.<\/li>\r\n \t<li><strong>Chemical injury<\/strong>\u00a0(e.g., ingestion of corrosives like bleach).<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h1><strong>Normal Gastric Protection<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Mucus layer<\/strong>: Protects the gastric wall from\u00a0<strong>HCl<\/strong>.<\/li>\r\n \t<li><strong>pH<\/strong>: Normally about\u00a0<strong>2<\/strong>, kept acidic for digestion.<\/li>\r\n \t<li><strong>Mucus production<\/strong>: Maintained by\u00a0<strong>mucous cells<\/strong>.<\/li>\r\n<\/ul>\r\n<h1><strong>Pathogenesis of Ulcers<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Decreased mucus production<\/strong>:\r\n<ul>\r\n \t<li>Due to\u00a0<strong>bacterial enzymes<\/strong>\u00a0degrading proteins and lipids.<\/li>\r\n \t<li>Affects the mucus barrier, exposing epithelium to acid.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Reduced blood flow<\/strong>:\r\n<ul>\r\n \t<li>Caused by\u00a0<strong>vasoconstriction<\/strong>\u00a0(stress, shock, smoking).<\/li>\r\n \t<li>Limits nutrients and\u00a0<em>mucus<\/em>\u00a0production.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Excess acid<\/strong>:\r\n<ul>\r\n \t<li>Due to\u00a0<strong>hypersecretion of gastrin<\/strong>\u00a0or\u00a0<strong>vagal overstimulation<\/strong>.<\/li>\r\n \t<li><strong>High acid levels<\/strong>\u00a0can damage mucosa if mucus barrier is compromised.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Chemical injury<\/strong>: Ingestion of\u00a0<strong>caustic substances<\/strong>\u00a0causes scarring and damage.<\/li>\r\n<\/ul>\r\n<h1><strong>Types and Locations<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Gastric ulcers<\/strong>: Located in the stomach lining.<\/li>\r\n \t<li><strong>Duodenal ulcers<\/strong>: Typically in the\u00a0<strong>proximal duodenum<\/strong>\u00a0(pyloric region).<\/li>\r\n \t<li><strong>Role of anatomy<\/strong>:\r\n<ul>\r\n \t<li>Ulcers tend to form where the mucosa is most exposed or weakened.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h1><strong>Progression<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Erosion<\/strong>: Ulcer erodes through the\u00a0<strong>mucosa<\/strong>\u00a0and\u00a0<strong>submucosa<\/strong>.<\/li>\r\n \t<li><strong>Further erosion<\/strong>: Can reach the\u00a0<strong>muscularis<\/strong>\u00a0layer.<\/li>\r\n \t<li><strong>Bleeding<\/strong>:\r\n<ul>\r\n \t<li>Ulcer may\u00a0<strong>bleed<\/strong>, causing blood in vomit (<strong>hematemesis<\/strong>).<\/li>\r\n \t<li>Blood might be\u00a0<strong>bright red<\/strong>\u00a0or\u00a0<strong>dark<\/strong>\u00a0(melena).<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Perforation<\/strong>:\r\n<ul>\r\n \t<li>Ulcer causes a\u00a0<strong>hole<\/strong>\u00a0in the wall.<\/li>\r\n \t<li>Leads to\u00a0<strong>chemical peritonitis<\/strong>\u00a0(inflammation in the peritoneal cavity).<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h1><strong>Complications<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Hemorrhage<\/strong>:\r\n<ul>\r\n \t<li>Bleeding can cause\u00a0<strong>shock<\/strong>.<\/li>\r\n \t<li>May require\u00a0<strong>endoscopic intervention<\/strong>\u00a0or\u00a0<strong>surgery<\/strong>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Perforation<\/strong>:\r\n<ul>\r\n \t<li>Gastric contents spill into the abdominal cavity.<\/li>\r\n \t<li>Causes\u00a0<strong>severe inflammation<\/strong>\u00a0(<strong>peritonitis<\/strong>).<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Scarring and stricture<\/strong>:\r\n<ul>\r\n \t<li>Healing scars can\u00a0<strong>narrow the lumen<\/strong>.<\/li>\r\n \t<li>Can lead to\u00a0<strong>obstruction<\/strong>\u00a0and\u00a0<strong>vomiting<\/strong>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Muscle layer death<\/strong>:\r\n<ul>\r\n \t<li>Muscle cells do\u00a0<strong>not regenerate<\/strong>.<\/li>\r\n \t<li>Scar tissue weakens the wall, increasing perforation risk.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h1><strong>Diagnosis and Treatment<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Imaging<\/strong>:\r\n<ul>\r\n \t<li><strong>Endoscopy<\/strong>\u00a0and\u00a0<strong>biopsies<\/strong>.<\/li>\r\n \t<li><strong>Barium swallow<\/strong>\u00a0X-rays.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Testing<\/strong>:\r\n<ul>\r\n \t<li>Stool tests for\u00a0<strong>H. pylori<\/strong>.<\/li>\r\n \t<li>Blood tests for\u00a0<strong>hemoglobin<\/strong>\u00a0and\u00a0<strong>Bilirubin<\/strong>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Treatment<\/strong>:\r\n<ul>\r\n \t<li><strong>Antibiotics<\/strong>\u00a0for H. pylori.<\/li>\r\n \t<li><strong>Proton pump inhibitors<\/strong>\u00a0or\u00a0<strong>H2 blockers<\/strong>\u00a0to reduce acid.<\/li>\r\n \t<li><strong>Alleviate symptoms<\/strong>\u00a0with proper diet and lifestyle.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h1><strong>Prevention<\/strong><\/h1>\r\n<ul>\r\n \t<li>Avoid NSAIDs, alcohol, caffeine.<\/li>\r\n \t<li>Quit smoking.<\/li>\r\n \t<li>Reduce stress.<\/li>\r\n \t<li>Use medications as prescribed to suppress acid.<\/li>\r\n<\/ul>\r\n<h1><span style=\"text-align: initial;font-size: 1em\"><b>Summary<\/b><\/span><\/h1>\r\n<span style=\"text-align: initial;font-size: 1em\">Ulcers are a serious condition that can lead to life-threatening bleeding and perforation if untreated. Early diagnosis and appropriate treatment are vital.<\/span>","rendered":"<p><strong>Peptic Ulcers: Causes, Pathophysiology, and Complications<\/strong><\/p>\n<h1><strong>Main Cause<\/strong><\/h1>\n<ul>\n<li><strong>Helicobacter pylori<\/strong>\u00a0bacteria:\n<ul>\n<li>Causes approximately\u00a0<strong>10 million Canadians<\/strong>\u00a0to be infected.<\/li>\n<li>Contributes to\u00a0<strong>gastric<\/strong>\u00a0and\u00a0<strong>duodenal ulcers<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<li>Other contributing factors:\n<ul>\n<li><strong>NSAIDs<\/strong>\u00a0(e.g., aspirin) and\u00a0<strong>aspirin<\/strong>\u00a0use.<\/li>\n<li><strong>Excessive alcohol and caffeine<\/strong>.<\/li>\n<li><strong>Stress<\/strong>\u00a0and\u00a0<strong>smoking<\/strong>.<\/li>\n<li><strong>Chemical injury<\/strong>\u00a0(e.g., ingestion of corrosives like bleach).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h1><strong>Normal Gastric Protection<\/strong><\/h1>\n<ul>\n<li><strong>Mucus layer<\/strong>: Protects the gastric wall from\u00a0<strong>HCl<\/strong>.<\/li>\n<li><strong>pH<\/strong>: Normally about\u00a0<strong>2<\/strong>, kept acidic for digestion.<\/li>\n<li><strong>Mucus production<\/strong>: Maintained by\u00a0<strong>mucous cells<\/strong>.<\/li>\n<\/ul>\n<h1><strong>Pathogenesis of Ulcers<\/strong><\/h1>\n<ul>\n<li><strong>Decreased mucus production<\/strong>:\n<ul>\n<li>Due to\u00a0<strong>bacterial enzymes<\/strong>\u00a0degrading proteins and lipids.<\/li>\n<li>Affects the mucus barrier, exposing epithelium to acid.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Reduced blood flow<\/strong>:\n<ul>\n<li>Caused by\u00a0<strong>vasoconstriction<\/strong>\u00a0(stress, shock, smoking).<\/li>\n<li>Limits nutrients and\u00a0<em>mucus<\/em>\u00a0production.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Excess acid<\/strong>:\n<ul>\n<li>Due to\u00a0<strong>hypersecretion of gastrin<\/strong>\u00a0or\u00a0<strong>vagal overstimulation<\/strong>.<\/li>\n<li><strong>High acid levels<\/strong>\u00a0can damage mucosa if mucus barrier is compromised.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Chemical injury<\/strong>: Ingestion of\u00a0<strong>caustic substances<\/strong>\u00a0causes scarring and damage.<\/li>\n<\/ul>\n<h1><strong>Types and Locations<\/strong><\/h1>\n<ul>\n<li><strong>Gastric ulcers<\/strong>: Located in the stomach lining.<\/li>\n<li><strong>Duodenal ulcers<\/strong>: Typically in the\u00a0<strong>proximal duodenum<\/strong>\u00a0(pyloric region).<\/li>\n<li><strong>Role of anatomy<\/strong>:\n<ul>\n<li>Ulcers tend to form where the mucosa is most exposed or weakened.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h1><strong>Progression<\/strong><\/h1>\n<ul>\n<li><strong>Erosion<\/strong>: Ulcer erodes through the\u00a0<strong>mucosa<\/strong>\u00a0and\u00a0<strong>submucosa<\/strong>.<\/li>\n<li><strong>Further erosion<\/strong>: Can reach the\u00a0<strong>muscularis<\/strong>\u00a0layer.<\/li>\n<li><strong>Bleeding<\/strong>:\n<ul>\n<li>Ulcer may\u00a0<strong>bleed<\/strong>, causing blood in vomit (<strong>hematemesis<\/strong>).<\/li>\n<li>Blood might be\u00a0<strong>bright red<\/strong>\u00a0or\u00a0<strong>dark<\/strong>\u00a0(melena).<\/li>\n<\/ul>\n<\/li>\n<li><strong>Perforation<\/strong>:\n<ul>\n<li>Ulcer causes a\u00a0<strong>hole<\/strong>\u00a0in the wall.<\/li>\n<li>Leads to\u00a0<strong>chemical peritonitis<\/strong>\u00a0(inflammation in the peritoneal cavity).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h1><strong>Complications<\/strong><\/h1>\n<ul>\n<li><strong>Hemorrhage<\/strong>:\n<ul>\n<li>Bleeding can cause\u00a0<strong>shock<\/strong>.<\/li>\n<li>May require\u00a0<strong>endoscopic intervention<\/strong>\u00a0or\u00a0<strong>surgery<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Perforation<\/strong>:\n<ul>\n<li>Gastric contents spill into the abdominal cavity.<\/li>\n<li>Causes\u00a0<strong>severe inflammation<\/strong>\u00a0(<strong>peritonitis<\/strong>).<\/li>\n<\/ul>\n<\/li>\n<li><strong>Scarring and stricture<\/strong>:\n<ul>\n<li>Healing scars can\u00a0<strong>narrow the lumen<\/strong>.<\/li>\n<li>Can lead to\u00a0<strong>obstruction<\/strong>\u00a0and\u00a0<strong>vomiting<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Muscle layer death<\/strong>:\n<ul>\n<li>Muscle cells do\u00a0<strong>not regenerate<\/strong>.<\/li>\n<li>Scar tissue weakens the wall, increasing perforation risk.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h1><strong>Diagnosis and Treatment<\/strong><\/h1>\n<ul>\n<li><strong>Imaging<\/strong>:\n<ul>\n<li><strong>Endoscopy<\/strong>\u00a0and\u00a0<strong>biopsies<\/strong>.<\/li>\n<li><strong>Barium swallow<\/strong>\u00a0X-rays.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Testing<\/strong>:\n<ul>\n<li>Stool tests for\u00a0<strong>H. pylori<\/strong>.<\/li>\n<li>Blood tests for\u00a0<strong>hemoglobin<\/strong>\u00a0and\u00a0<strong>Bilirubin<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Treatment<\/strong>:\n<ul>\n<li><strong>Antibiotics<\/strong>\u00a0for H. pylori.<\/li>\n<li><strong>Proton pump inhibitors<\/strong>\u00a0or\u00a0<strong>H2 blockers<\/strong>\u00a0to reduce acid.<\/li>\n<li><strong>Alleviate symptoms<\/strong>\u00a0with proper diet and lifestyle.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h1><strong>Prevention<\/strong><\/h1>\n<ul>\n<li>Avoid NSAIDs, alcohol, caffeine.<\/li>\n<li>Quit smoking.<\/li>\n<li>Reduce stress.<\/li>\n<li>Use medications as prescribed to suppress acid.<\/li>\n<\/ul>\n<h1><span style=\"text-align: initial;font-size: 1em\"><b>Summary<\/b><\/span><\/h1>\n<p><span style=\"text-align: initial;font-size: 1em\">Ulcers are a serious condition that can lead to life-threatening bleeding and perforation if untreated. Early diagnosis and appropriate treatment are vital.<\/span><\/p>\n","protected":false},"author":1370,"menu_order":15,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":["zoe-soon"],"pb_section_license":"cc-by-nc-sa"},"chapter-type":[],"contributor":[60],"license":[57],"class_list":["post-5378","chapter","type-chapter","status-web-only","hentry","contributor-zoe-soon","license-cc-by-nc-sa"],"part":67,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5378","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/users\/1370"}],"version-history":[{"count":1,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5378\/revisions"}],"predecessor-version":[{"id":5379,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5378\/revisions\/5379"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/parts\/67"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5378\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/media?parent=5378"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapter-type?post=5378"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/contributor?post=5378"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/license?post=5378"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}