Sandbox cerebral palsy: Difference between revisions
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**During stress, there is acid hypersecretion; therefore, the breakdown of mucosal defenses leads to injury of the mucosa and subsequent bleeding. | **During stress, there is acid hypersecretion; therefore, the breakdown of mucosal defenses leads to injury of the mucosa and subsequent bleeding. | ||
**Mucosal defects along with dilated and tortuous vessels in dieulafoy lesion put them at risk for rupture because of necrosis of the arterial wall from exposure to gastric acid. | **Mucosal defects along with dilated and tortuous vessels in dieulafoy lesion put them at risk for rupture because of necrosis of the arterial wall from exposure to gastric acid. | ||
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{{familytree | | | | | | | | | | C01 | | | | C02 | | | | C03 | | |C01=C01|C02=C02|C03=C03}} | {{familytree | | | | | | | | | | C01 | | | | C02 | | | | C03 | | |C01=C01|C02=C02|C03=C03}} | ||
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Revision as of 16:43, 18 December 2017
Pathophysiology
Mucosal barrier
- The gastric mucosa is protected from the acidic environment by mucus, bicarbonate, prostaglandins, and blood flow.
- This mucosal barrier consists of three protective components which include:
- Layer of epithelial cells lining.
- Layer of mucus, secreted by surface epithelial cells and Foveolar cells.
- Bicarbonate ions, secreted by the surface epithelial cells.
Mechanism of Action
- The insoluble mucus forms a protective gel-like coating over the entire surface of the gastric mucosa.
- The mucus protects the gastric mucosa from autodigestion by e.g. pepsin and from erosion by acids and other caustic materials that are ingested.
- The bicarbonate ions act to neutralize harsh acids.
- If the balance of gastric acid secretion and mucosal defenses is disrupted, acid interacts with the epithelium to cause damage
Pathogenesis
- Regardless of etiology, if the balance of gastric acid secretion and mucosal defenses is disrupted, acid interacts with the epithelium to cause damage.
- Helicobacter pylori disrupts the mucosal barrier and causes inflammation of the mucosa of the stomach and duodenum.
- As the ulcer progresses beyond the mucosa to the submucosa the inflammation causes weakening and necrosis of arterial walls, leading to pseudoaneurysm formation followed by rupture and hemorrhage.
- NSAIDs inhibit cyclooxygenase, leading to impaired mucosal defenses by decreasing mucosal prostaglandin synthesis.
- During stress, there is acid hypersecretion; therefore, the breakdown of mucosal defenses leads to injury of the mucosa and subsequent bleeding.
- Mucosal defects along with dilated and tortuous vessels in dieulafoy lesion put them at risk for rupture because of necrosis of the arterial wall from exposure to gastric acid.
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