Peptic Ulcer

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Peptic ulceration is due to a breakdown of normal protective mechanisms.
Peptic ulcers may be acute or chronic
Peptic ulcers are caused by damage to the gastric lining by gastric secretions, particularly acid.
Acute peptic ulcers usually develop from areas of erosive gastritis and are predisposed by the
same conditions as erosive gastritis.
They may cause severe bleeding, heal without scarring, or progress to form a chronic peptic ulcer.

Important causes of acute peptic ulcers are severe stress or shock
(e.g. after major trauma or burns), with hypotension; acute hypoxia of the surface epithelium may be
an important pathogenic mechanism.

The main sites of chronic peptic ulceration are the lower oesophagus (due to gastric reflux),
the stomach, the duodenum, and gastroenterostomy sites.
Chronic ulcers may be 1-7 cm in diameter or even larger.

They have sharply defined borders without any heaping up of the epithelium surrounding the
ulcer crater. The floor of the ulcer is composed of fibrous scar tissue, overlaid by granulation
tissue, inflammatory exudate and necrotic slough.

The ulcer crater usually penetrates into the muscularis propria of the stomach, and complete
healing of the ulcer leads to fibrous replacement of muscle, with re-growth of epithelium over the scar.
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