A peptic ulcer is associated with all except one
Correct Answer: Pernicious anemia
Description: You, don't expect pernicious anemia to cause peptic ulcer. In pernicious anemia, there is autoimmune destruction of the parietal cells leading to hypochlorhydria which fuher progresses to achlorhydria Etiology. of peptic ulcer Acute Peptic Ulcer NSAIDS Ingestion Stress Cushing ulcer after cerebral trauma Curling ulcer* after burn injury, any kind of shock Sepsis -- Undrained pus may be responsible for an acute ulcer. Steroids Chronic Gastric Ulcer NSAIDs Ingestion NSAIDs disrupt the prostaglandin driven suppo of the mucosal barrier. Prostaglandins are responsible for the prodn. of mucosal gel layer in the stomach, which provide a protective barrier to the gastric and duodenal lining. So disruption of this mucosal barrier allows even minimum amount of acid to cause ulceration. Helicobacter pylori H.Pylori is seen in almost 90% of cases of duodenal ulcer and 70% of cases of gastric ulcer. Pyloroduodenal reflux Regurgitate bile & other duodenal juices. Mucosal trauma by mechanical effect of food. Diet & smoking Irregular diet, spicy food excessive drinking of tea & coffee, alcohol, Cigarette smoking has a definite relation with both gastric & duodenal ulcers. Emotional factors Anxiety, Stress & strain. Liver disease Ulceration of both stomach and duodenum have co-existed with the disease of the liver, paicularly cirrhosis. It may be due to increase in blood supply to the gastric mucosa and overproduction of histamine in the stomach wall to stimulate the parietal cell. Chronic Duodenal Ulcer Acid hypersecretion Genetic factors Persons of blood group 'O' who do not possess AB antigen are peculiarly apt to develop a duodenal ulcer. iii.Endocrinal disorders Zollinger Ellison syndrome Hyperparathyroidism Multiple adenoma syndromes (MEN-I) Cushing. syndrome (b/c of the high level of endogenous steroids) Chronic liver diseases Chronic lung disease Chronic pancreatitis Emotional factor Diet & smoking H.pylori The decrease in bicarbonate production The list may be exhaustive but questions have been repeatedly asked on etiology of peptic ulcers. Ref : S.Das text book, 3/e p818
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