ALCOHOL

DRUG: NSAID Stress

SMOKING
Nicotine
stimulants
Inhibits COX1 & COX2
vasoconstriction mucosal blood flow and motility
↑parasympathetic
Blocks Prostaglandin
nerve activity to the
synthesis
Blood supply GI tract Stasis of chyme and
↑glucocorticoid effects
Mucin Secretion, HCO3 secretion, H-pylori
Interferes with the rapid regeneration
Surface active phospholipid
Colonizes antral mucosa
of epithelium , production of mucus,
secretion, Epithelial cell
secretion of alkaline bicarbonate ion, Antibiotic,
Antibiotic,
proliferation, HCL secretion proton
proton pump
pump Secretes cytotoxins and
secretion of protective prostaglandins inhibitor,
inhibitor, enzymes protease,
bismuth
bismuth salts
salts phospholipase, and urease

↑Stimulation to
enterochromaffin- Relaease of ammonia
Acid & pepsin
like cells and g-cells release

Ur
Damage to ea
mucosal defenses br
and membrane
ea
Imbalanced th
aggressive and tes
defensive factors t
↓mucosal cells, ↓quality
H2
H2 receptor
receptor antagonist,
antagonist,
of mucous, ↓tight proton
proton pump
pump inhibitor
inhibitor
junction between cells
 Infection ↑gastrin
Allowing chyme to Healing with
and↓somatostatin
enter peritoneal scarring
production
Endo cavity
scopy
Erosion to Perforation
Peritonitis/ inflammation of Dislodgement of the
the lining of
peritoneal membrane and scar tissue around the
the stomach
other structure of duodenum or pylorus
abdominal cavity
Erosion of large Ulcer may Rupture of small
blood vessel erode to blood vessels
↑permeability of intestinal Obstruction of the
blood vessels
wall, passage of bacteria and digestive tract
Massive Hemorrhage Occult blood in their toxins into the peritoneal
Hemorrhage stool cavity and bacterial peritonitis
Fecal
Hematemesis, Iron- deficiency Occult
shock, Anemia Blood
Test,
Could not secrete stool
enough mucus to act as Billroth
Billroth II
Severe antige
Gastroduodenosco
Gastroduodenosco
a protection
ulcerations/peptic  Epigastric
n test pain py
py
ulcer  Hematemesis
Resistant to
standard medical
Zollinger-Ellison  Dyspepsia
syndrome
therapy  Pyrosis
(gastrinoma)