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XI.

PATHOPHYSIOLOGY
Contributory factor:
Diet: caffeine intake
Alcohol and smoking
Presence of Helicobacter
pylori infection Precipitating factors:
Emotional stress Age: 40-60 years old
Skipping meal Gender: male
Multiple use of NSAIDS
Irritating foods

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 S/Sx: Abdominal Pain


Decreased quality of mucus
Loss of tight junctions between cells

Back diffusion of acid into gastric


mucosa

Conversion of pepsinogen Increase acid secretion


to pepsin

Stimulation of S/Sx:
Further mucosal erosion cholinergic intramural Abdomi-
Destruction of blood plexus, causing muscle nal Pain
vessels PEPTIC ULCER spasm
BLEEDING
Mucosal injury DISEASE
&
cOAGULOPATT
UPPER GASTROINTESTINAL
BLEEDING/HEMORRHAGE
S/Sx: Melena &
Hemoglobin level: 89 g/L
Hematemesis
Decreased volume of
Hematocrit level: 26 g/L
circulating blood in the
Red Blood Cell lvl: 2.9
body.
x106/uL
S/Sx:
Decrease Hemoglobin, Pallor
Hematocrit & RBC. Weakness
Restlessness
tachypnea (RR-28)
HYPOVOLEMIA Hypotension (90/60
mmhg)