Ans is 'd' ie Pernicious anemia You, dont 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 i) NSAIDS Ingestion ii) Stress - Cushing ulcer after cerebral trauma - Curling ulcer* after burn injury, any kind of shock iii) Sepsis -- Undrained pus may be responsible for acute ulcer. iv) Steroids * Chronic Gastric Ulcer i) 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. ii) Helicobacter pylori - H.Pylori is seen in almost 90% of cases of duodenal ulcer and 70% of cases of gastric ulcer. iii) Pyloroduodenal reflux - Regurgitate bile & other duodenal juices. iv) Mucosal trauma - by mechanical effect of food. v) Diet & smoking - Irregular diet, spicy food excessive drinking of tea & coffee, alcohol, Cigarette smoking has a definite relation with both gastric & duodenal ulcers. vi) Emotional factors - Anxiety, Stress & strain. vii) Liver disease - Ulceration of both stomach and duodenum have co-existed with 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 i) Acid hypersecretion ii) Genetic factors - Persons of blood group '0' who do not possess AB antigen are peculiarly apt to develop duodenal ulcer. iii) Endocrinal disorders - Zollinger Ellison syndrome Hyperparathyroidism - Multiple adenoma syndrome (MEN-I) - Cushing syndrome (b/c of high level of endogenous steroids) iv) Chronic liver diseases v) Chronic lung disease vi) Chronic pancreatitis vii) Emotional factor viii) Diet & smoking ix) H.pylori x) Decrease in bicarbonate production The list may be exhaustive but questions have been repeatedly asked on etiology of peptic ulcers.