Precipitating factors:

Diet: eating raw, spicy foods and

drinking caffeinated beverages
Prolonged use of NSAIDs
(Naproxen) before meal
Skipping meal

Predisposing factors:
Age >60 (80 y/o)
Male (2:1)
Blood type A



Decrease secretion of mucous in
stomach and reduce integrity of
mucosa
Destruction of mucous barriers
Inflammatory effects on mucosa
Ulcers burrows
Sign and Symptoms:
Epigastric pain
Heart burn
Exposing and Weakening of arterial wall
Laboratory findings:
Increase gastric acidity secretion and
peptic acid
Ruptured arterial wall
UPPER GASTROINTESTINAL
BLEEDING
Signs and symptoms:
Hematemesis
Vomiting with undigested
food
Melena
Dysphagia
Weight loss



Prolonged bleeding
Complication:
Anemia
Sign and Symptoms
Dizziness -Easy fatigability
Weakness -Headaches,
Dehydration -Pale nail bed with 4 sec.
capillary refill
Laboratory:
Date:
Peptic ulcer
Inhibiting
Cyclooxygenase
Decreased mucosal
prostaglandin synthesis
Edema and scarring of the ulcer
Healing and fibrosis
Obstruction of the gastroduodenal junction
Interpretation:
Mr. P. A has precipitating and predisposing factors that led to his present condition.
Predisposing factors incline the condition of the client which are the age greater than 60, the risk
population is male with 2:1 ratio of male to female and people with blood type A. Precipitating
factors are considered as factors causing a condition happen quickly include skipping meals,
taking caffeinated drinks, eating raw and spicy foods. According to ----------- these affect the
secretion of gastric acid. He also use NSAIDs like Naproxen for a long period of time that cause
gastric and duodenal ulcers by inhibiting cyclooxygenase, which causes decreased mucosal
prostaglandin synthesis and results in impaired mucosal defenses and reduce integrity of mucosa.
Prolonged used of NSAIDs increase in gastric burrows leading to peptic ulcer. The presence of
gastric ulceration exposing and weakening the arteries then arterial wall ruptured causing to
upper gastrointestinal bleeding includes inner lining (mucosa) of the esophagus, stomach, or
proximal small intestine (duodenum). In a peptic ulcer it is believed to be a result of edema and
scarring of the ulcer, followed by healing and fibrosis, which leads to obstruction of the
gastroduodenal junction with signs and symptoms of hematemesis, vomiting of undigested foods
melena, dysphagia, weight loss. Laboratory findings are---------------------. Prolonged bleeding
can lead to complications like Anemia that was also presented in the client. Mr. P.A possessed
dizziness when changing positiion, easy fatigability, weakness, headaches, dehydration, and pale
nail bed with 4 sec. capillary refill. Laboratory findings are--------------------------





Definition of CYCLOOXYGENASE
an enzyme that catalyzes the conversion of arachidonic acid to prostaglandins, that
is inactivated by aspirin and other NSAIDs, and that has two isoforms of which one
is involved in the cascade of events producing the pain and inflammation of arthritis
and the other is notsee COX-1,COX-2

Definition of ARACHIDONIC ACID
: a liquid unsaturated fatty acid C
20
H
32
O
2
that occurs in most animal fats, is a
precursor of prostaglandins, and is considered essential in animal nutrition




Layers of the Stomach Wall



















Above: Diagram of the Stomach Wall.

The epithelial cells that line the stomach form the mucosal epithelium layer.
When the stomach is empty the mucosa lies in large folds called rugae and which look like
wrinkles. The rugae flatten as the stomach fills. In order to identify the different types of cells
that line the stomach and the functions of each of these types of cells it is necessary to describe
the inner-layers of the stomach (i.e. the layers of the mucosa).
The surface of the mucosa is a layer of nonciliated simple columnar epithelial cells
called surface mucous cells.
There are also many columns of secretory cells called gastric glands that line narrow
channels called gastric pits.
That is, epithelial cells not only line the inside surface of the stomach, but also form many
narrow passages called gastric pitsthat lead from the lumen of the stomach outwards towards
the inner stomach wall, or submucosa.

(2) The Mucosa (of the Stomach)














The cells identified in the diagram above are:
Surface Mucous Cells (or "Mucous Surface Cells") - which secrete mucus.
Neck Mucous Cells (or "Mucous Neck Cells") - which secrete a mucus whose acidity
is more neutral than that secreted by the cells at the surface of the stomach lining.
Chief Cells
Parietal Cells, and
G Cells
Gastric Glands lining the Gastric Pits:
There are three special types of exocrine glands (neck mucous cells, chief cells and parietal
cells) that secrete chemicals into the stomach. There is also one type of hormone-producing
cell in the lining of the gastric pits, which is called a G cell.

(3) Secretions from cells located in the Stomach
Type of Cell Secretion Notes
Surface Mucous
Cells
(or "Mucous Surface
Cells")
- secrete a mucus
Neck Mucous Cells
(or "Mucous Neck
Cells")
- secrete a mucus whose
acidity is more neutral than
that secreted by the cells at
the surface of the stomach
lining.
The mucus secreted by the muscous
neck cells has a more neutral pH than
that secreted by the cells at the surface
of the stomach lining.
Chief Cells - secrete pepsinogen Pepsinogen is an inactive
gastric enzyme which is converted
to pepsin, a protein-digesting enzyme.
Parietal Cells - secrete hydrochloric
acid, and anintrinsic
factor (involved in the
absorption of vitamin B
12
).
Hydrochloric acid assists in the
conversion of pepsinogen to pepsin
(mentioned above).
Insufficient intrinsic factor can lead to
pernicious anemia because vitamin
B
12
is necessary for the production of red
blood cells (called erythrocytes).
Gastric Juice:
The secretions of the surface mucous cells, neck mucous cells, chief
cells, and parietal cells are known collectively as gastric juice.
(Hence gastric juice includes mucous, pepsinogen, hydrochloric
acid and intrinsic factor.)
G Cells - produce and secrete the
hormonegastrin.
Gastrin :
stimulates secretion of gastric
juice,
increases the contractions of the
gastro-intestinal (GI) tract, and
relaxes the pyloric sphincter.