PPT of Acid Peptic Disorders Introduction and Pathophysiology

1. Dr. Suse S.B.
MD, PhD Scholar, Kayachikitsa
Associate Professor, GAC Jalgaon

2. 
 Collection of diseases involving acid production in
the stomach and nearby parts of the GIT
 It includes
1. Gastritis, Duodenitis, Gastro duodenitis
2. Gastroesophageal reflux disease (GERD)
3. Peptic Ulcer –
• Oesophageal ulcer
• Gastric Ulcer
• Duodenal Ulcer
• Gastroduodenal Ulcer
4. Zollinger Ellison (ZE) Syndrome
Acid Peptic Disorders

3. 
 Stomach secretes 2-3 liters of gastric juice
/day.
 Secretions of different cells in Stomach
 Chief/peptic cells secrete - pepsinogen.
 Parietal or oxyntic cells secrete - acid and IF.
 Superficial epithelial cells secrete - alkaline
mucus and bicarbonates.
Physiology of Gastric Secretions

4. 
Secretions in systemic circulation which act as a
stimulus to regulate gastric acid secretion -
 G cells - Gastrin
 ECL (Enterochromaffin like) cells - Histamine
 Vagus Nerve - Acetylcholine
 D cells - Somatostatin
 prostaglandin-E2
Regulation of gastric acid
secretion

5. 

6. 

7. 
Pathophysiology
.
Imbalance between Aggressive & Defensive factors
Aggressive
factors
Hydrochloric
acid and
pepsin
destroy gastric and duodenal
mucosa.
Defensive
factors
Mucus and
bicarbonate
ion
secretions
protect mucosa Na bicarbonate is
considered as a buffer so it inhibits
auto digestion of the stomach wall
Prostaglandins
(PGE2 &
PGI2)
protect
mucosa by
inhibiting acid secretion
increasing mucus and
bicarbonate production
enhancing mucosal blood
flow.

8. 
 Prostaglandin
 Main action of PGs is increase turnover and
regeneration of damaged cells
 H. Pylori infection play major role in pathogenesis

9. 

10. 
• Gnawing or burning ache or pain (indigestion) in your
upper abdomen that may become either worse or
better with eating.
• Nausea.
• Vomiting.
• A feeling of fullness in your upper abdomen after
eating
Gastritis

11. 
Peptic Ulcer

12. 
 Damage to the mucosa
 deeper tissue exposed to acid and pepsin
Peptic ulcer

13. 
Etiology
o H. pylori infection is the major etiological factor in
peptic ulcer disease (95% in duodenal and 80% in
gastric ulcer).
o Drugs (e.g.) NSAIDs; corticosteroids,
o Hypersecretory states (Zollinger Ellison syndrome)
‘Gastrinomas’ - “Gastrin inducing tumor”
o Alcohol
o Smoking
o Caffeine
o Diet – Spicy food
o Genetic factors

14. 
 H. Pylori infection – Inflammation of Stomach –
Gastritis, Duodenitis
 Sometimes lead to Stomach Cancer, Lymphoma
H-Pylori Infection

15. 
a. Gastric ulcers, b. Gastritis,
c. Esophagitis, d. Duodenal ulcer

16. 
Gastric Ulcer Duodenal Ulcer
Age Between Age group 50-60 Between Age group 20-50
Male: Female Ratio Almost equal 2:1
Pain Felt over the Umbilicus and
Left to Midline
Felt above the Umbilicus and
Right to midline
Radiation No radiation May radiate to back
Nature Periodical Periodical
Aggravating Factors Immediately after food 1-2 hours after food, when the
stomach gets empty, Middle of
the night or sleep
Ameliorating Factors Vomiting or Alkali food After taking food
Weight Loss Present dur to reduced intake No weight loss as patient feels
better with eating and hence
goes on eating
Gastric Symptoms Sensation of filling Fulness,
indigestion, Heartburn, gas
trouble and belching
Bloated feeling of intestinal
gases
Haemorrhage Hematemesis (Blood
Vomiting) may be present
Malena (Black or bloody stool)
may be present

17. 
Thank You