PATHOPHYSIOLOGY OF BLEEDING PEPTIC ULCER

Contributory factor: Precipitating factors:

 Diet: caffeine intake  Age: 50-70 years old
 Alcohol and smoking  Gender: male
 Presence of Helicobacter
pylori infection

Increase hydrochloric acid (HCL)

production

Irritation of the lining (mucosal) of the

stomach, duodenum, proximal of small
intestines

Damaged mucosal barrier Inflammatory process

Decreased function of mucosal cells

Decreased quality of mucus
Loss of tight junctions between cells

Back diffusion of acid into gastric

mucosa

Conversion of pepsinogen Formation of liberation of

to pepsin histamine

Increase acid secretion

Local vasodilation
Further mucosal erosion
Destruction of blood
Stimulation of cholinergic
vessels Increase capillary permeability
intramural plexus,
Loss of plasma proteins
Mucosal injury Ulceration causing muscle spasm
Mucosal edema
Loss of plasma into gastric
lumen
Bleeding/
Hemorrhage

Decreased oxygen carrying

capacity as manifested by
decreased hemoglobin and
hematocrit level