Peptic Ulcer Disease (PUD)

An ulceration that develops in the gastrointestinal

mucosa when gastric acid and pepsin overwhelm
mucosal defenses and destroy mucosal tissue

Symptoms: epigastric pain experienced as a

hunger pain, a sensation of gnawing, or a
burning pain; sometimes accompanied by
weight loss, vomiting of blood; sudden
weakness, tarry stools
Etiology:

Helicobacter pylori infection

Use of NSAIDs (have both topical and systemic effects

that can damage mucosal tissue)

Zollinger-Ellison syndrome, characterized by the presence

of gastrin-secreting tumors in the duodenum or
pancreas.

Stimulants of gastric acid secretion (cigarette smoking,

stress, spices, sex (more common in males) and genetic
factors
 Accessory organs
Liver, gallbladder, and pancreas
They play a vital role in the production of
digestive and absorptive agents
 Liver

The largest gland in the body

located just beneath the
diaphragm

Triangular in shaped and

weighing about 1500 g
 Disease of the liver
Fatty liver refers to the failure of the liver to
metabolize fat due to inflammation, hepatic
injury or poor fat transport; insulin resistance;
increased fat synthesis.

Hepatitis inflammation of the liver caused by

alcohol, infection, parasites, drugs, and some
supplements.
 Cirrhosis
- The most serious and irreversible type of liver
injury.
- A chronic liver disease where increased fibrous
connective tissue replaces the functioning liver cells
following fatty regeneration of long standing.
- A cirrhotic liver is often shrunken and has an
irregular, nodular appearance. Cirrhosis impairs liver
function and can eventually lead to liver failure.
Causes of Cirrhosis:

Alcoholic liver disease

Autoimmune hepatitis
Bile duct obstructions
- Complications of gallbladder surgery
- Cystic fibrosis Diseases that cause bile duct injury
Drug-induced liver injury
Inherited disorders
- Galactosemia
- Glycogen storage disease
- Hemochromatosis (causes excessive liver iron)
Wilsons disease (causes excessive liver copper)
 Steatohepatitis (fatty liver disease)
Viral hepatitis
- Hepatitis B
- Hepatitis C
Consequences:

Portal hypertension- increased blood pressure

due to obstructed blood flow to the liver
Ascites accumulation of fluids in the abdominal
cavity
Esophageal varices distended blood vessels due
to obstruction
Collateral formation blood vessels that develop
when the blood flow to the liver is obstructed
Hyperammonemia- elevated ammonia in the
blood
Types:
Biliary cirrhosis-diseases of the bile duct
Post-necrotic complication of hepatitis
Laennecs cirrhosis linked with chronic alcoholism
Nonalcoholic
Obstructive cirrhosis obstruction of the bile duct
Cardiac cirrhosis complication of heart failure
Toxic exposure to chemicals, poisons
Inborn errors or metabolic wilsons disease,
hemochromatosis
Idiopathic- if the cause is unknown
 Hepatic coma also called as portal systemic
encephalopathy, liver malfunction
characterized by confusion, apathy and
neurological dysfunstion; fecal odor of breath,
flapping tremor (allows muscle to flap like
wings), anemia, and hepatorenal syndrome
Table 1. Laboratory test for the evaluation of liver disease.
 The gallbladder
Concentrates and stores
the bile produced by the
liver until the bile is
needed for fat digestion
Disorders that obstruct
the livers release of bile
can damage the liver.
 Diseases of the gallbladder
1. Inflammation of the gallbladder/gallstones
Cholecystitis inflammation of the gallbladder
Cholelithiasis-presence or formation of gallstones
Cholecystolithiasis presence of one or more gallstones
in the gallbladder
Choledocholithiasis occurrence of stone in the biliary
tree (cyctic duct, heaptic duct, common bile duct)
Cholangitis inflammtion of the biliary tree
2. Biliary dyskinesia refers to the abnormal bile
flow due to increased (spastic) or decreased
contraction of the gallbladder

3. Jaundice the yellow discoloration of the

eyes and skin due to overflow of bile into the
general circulation
 Pancreas
The pancreas is an elongated, flattened gland that lies in
the upper abdomen behind the stomach
Pancreatic cells manufacture glucagon, insulin, and
somatostatin for absorption into the bloodstream
(endocrine function) for regulation of glucose
homeostasis
Other cells secrete enzymes and other substances
directly into the intestinal lumen, where they aid in
digesting proteins, fats, and carbohydrates (exocrine
function).
 Diseases of the pancreas
Pancreatitis inflammation of the pancreatic
tissue due to inadequate supply of blood or
obstruction to the flow of pancreatic juices

Cystic fibrosis refers to the accumulation of

mucus in the bronchi, pancreas, liver, and
intestines; causing damage and malfunction of
the organs and biliary cirrhosis
References:

Barrion ASA, de Juras AR, Padilla LM, Talavera MTM. Fundamentals in Nutrition and
Dietetics Vol.2:Medical Nutrition Therapy and Biochemistry.. Institute of Human
Nutrition and Food, College of Human Ecology, University of the Philippines Los
Baos.2013.

Jamorabo-Ruiz A, Claudio VS, Oliveros MS, De Castro EE, De Guzman MAP. Basic Diet
Therapy for Filipinos 4th ed. Philippine: Merrian & Webster Bookstore, Inc.1998.27-
55 pp.

Rolfes SR, Pinna K, Whitney E. Understanding Normal and Clinical Nutrition, 8th
ed.USA: Wadsworth, Cengage Learning 2009.