Jonathan Bland

Pathophysiology
Prof. Lori McGowan
Peptic Ulcer

A 50-year-old man was admitted to the hospital with severe abdominal pain and vomiting.
In the ER, the doctors found that his blood pressure was dropping significantly. He was taken to
the OR and the surgeons found that he had a perforated peptic ulcer.
How does a peptic ulcer develop? Peptic ulcers usually appear as single, small, round
cavities with smooth margins that penetrate the submucosal barrier, the tissues are exposed to
continued damage because acid diffuses into the gastric wall. Ulcers may erode more deeply
into the muscularis and eventually may perforate the wall. An area of inflammation surrounds
the crater. When the erosion invades a blood vessel wall, bleeding takes place. Bleeding may
involve persistent loss of small amounts of blood or massive hemorrhage, depending on the
size of the blood vessel involved. Chronic blood loss may be detected by the presence of irondeficiency anemia or occult blood in the stool; one of these may be the first indicator of peptic
ulcer. (Gould, 2006) There are also other considerations to be added when it comes to the
reasons why ulcers develop, stress, the adverse effects of glucocorticoids. Decrease mucus
secretions and thinning of the mucosa predisposes the older person to peptic ulcer
development. (Gould, 2006)
Is there any bacterium involved? If so, what is the name? Currently considered to be of
major significance is the presence of the bacterium Helicobacter pylori, found in the most
persons with peptic ulcer disease, although its precise role is not totally understood. Not all
persons with H. pylori infections develop ulcers, but eradication of the infection promotes rapid
healing of the ulcer. H. pylori is known to secrete cytotoxins and the enzymes protease,

phospholipase, and urease (which releases ammonia), all of which cause damage to mucosal
defenses. (Gould, 2006)
What are the factors that may lead to an ulcer? Stress is one of the leading candidates that
cause ulcers; another is psychological factors and smoking.
Contributing Factors. Certain factors may increase the risk for ulcers in NSAID users:

Age 65 and older

History of peptic ulcers or upper gastrointestinal bleeding
Other serious ailments, such as congestive heart failure
Use of other medications, such as the anticoagulant warfarin (Coumadin),
corticosteroids, or the osteoporosis drug alendronate (Fosamax)
Alcohol abuse
H. pylori infection
(University of Maryland, 2011)
How does perforation develop? Peptic ulcer results from erosion of the mucosal barrier

and is frequently associated with infection by H. pylori. Serious complications hemorrhage and
perforation.
Does the patient have peritonitis? With the patient having ruptured his peptic ulcer
there is a chance that peritonitis can occur along with sepsis, which is rare.

Works Cited
Gould, B. E. (2006). Pathophysiology for the Health Professionals, 3rd Edition. Philadelphia: W.B.
Sauders.

University of Maryland. (2011). Peptic Ulcers-Risk Factors. Retrieved March 11, 2011, from Univeristy of
Maryland Medical Center:
http://www.umm.edu/patiented/articles/who_gets_peptic_ulcers_000019_5.htm