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Tract
Gastro Intestinal
Tract
Organs of GIT
Oral cavity
Pharynx
Esophagus
Stomach
Small intestine
Large intestine
Gastro Intestinal
Tract
Accessory
Organs
Liver
Gallbladder
Pancreas
Spleen
Gastro Intestinal
Tract
Esophagus
Esophagus is a muscular, collapsible tube about 10
inches long, extending from the pharynx to the
stomach.
Parts of Stomach
Fundus
Body
Pylorus
Gastro Intestinal
Tract
Small Intestine
Duodenum
Jejunum
Ileum
Large Intestine
Caecum
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum
Anal canal
Gastro Intestinal
Tract
Saliva
Pancreatic secretion
Bile
Gastric secretion
Digestion and
Absorption
It is the secretion of the stomach.
The stomach mucosa has two
important types of tubular glands:
Pyloric Gland
Oxyntic gland
Pyloric Glands
They secrete :
Mucus (secreted by Mucus Cells)
Pepsinogen (secreted by Chief Cells)
Gastrin (secreted by G - Cells)
Oxyntic Glands
Cl- H+ K+ Cl-
H+/K+ ATPase
Cl- Na+
Na+ Na+ Na+
Na+
Step 1
Chloride ions ( Cl -) are transported
from cytoplasm into the lumen of
the canaliculi to create a negative
potential.
Step 3
Water (H2O) in the cytoplasm dissociates in to
hydroxyl ions (OH-) and hydrogen ions (H+)
Mechanism of HCl secretion by
parietal
cell
Step 4
Hydrogen ions ( H +) are then exchanged in the
canaliculi for potassium ions ( K + ).
This exchange process is brought about through the
presence of an enzyme
parietal
Thus potassium ions are reabsorbed in to
cell
the cell cytoplasm and hydrogen ions take
their place in the canaliculi.
Hydrogen ions then combine with Chloride
ions to make HCl.
The final secretion in the canaliculi is
extremely high in HCl.
Acid Related Diseases
Acid Related
Diseases
• Peptic ulcer
• Gastroesophageal reflux
disease (GERD)
• Gastritis
• NSAIDs and Peptic Ulcer
Ulcer
Mucus
HCO3
Pepsin
Prostaglandins
Gastric Mucosal
Gastric Acid Blood Flow
Peptic Ulcer
Sites
Duodenum 90 -95 % of duodenal ulcers
occur in first portion of
duodenum
Stomach More than 90% of gastric
ulcers occur in the lesser
curvature
Esophagus Lower end of Esophagus in
reflux esophagitis
Jejunum In zollinger Ellison syndrome
Peptic Ulcer
Peptic Ulcer
ETIOLOGY
Heredity
Acid pepsin vs mucosal resistance.
Factors reducing mucous
resistance
Association with other diseases
Peptic Ulcer
Heredity
Peptic ulcer tends to run in families.
• Severe burns
Peptic Ulcer
• Heart burn
• Regurgitation of food
in mouth
• Iron deficiency anemia
Gastro- Esophageal
Reflux
Disease (GERD)
Complications
• Esophagitis
• Benign esophageal sphincter
• Barrett’s esophagus
• Anemia
• Aspiration
GASTRITIS
It is the inflammation of gastric
mucosa and if persists leading to the
gastric ulcerations and erosions.
Etiology
Aspirin and other NSAIDS
Severe stress
Burns
Excessive alcohol consumption
GASTRITIS
– Aspirin
– Ibuprofen
– Diclofenac sodium
– Indomethacin
– Naproxen sodium
NSAIDs and Peptic Ulcer
• Normally the stomach has three defenses
against digestive juices:
– Mucus
– The chemical bicarbonate and Prostaglandins
– Blood circulation to the stomach lining that
aids in cell renewal and repair.
• It is spiral shaped,
flagellated, bacteria found
in stomach and duodenum.
• Increase in pepsinogen.
Management of
Acid Related Diseases
General Measures
Peptic Ulcer
No smoking
Avoid alcohol
Avoid aspirin
General Measures
• GERD
Weight reduction
Stop smoking
Meals should be of in small volume
Avoid heavy lifting and bending after
meals
Avoid late night meals to reduce reflux
during sleep.
Pharmacological
Treatment
It can be divided into the :
• Drugs enhancing the mucosal defense
• Acid suppression drugs.
a. Drugs enhancing
the mucosal defense
• These drugs act by strengthening the
defensive forces of gastric mucosa by
increasing the prostaglandin
synthesis , increase in mucus and
bicarbonate production.
Sucralfate
Mechanism Of Action
• It forms an adherent complex with proteins
in the ulcer base and protects it from
further digestion .
• It also stimulates mucus , prostaglandin
and mucus production.
• Available Brands
• Ulsanic, Ulcocid, Sucrafate, Sucemed.
a. Drugs enhancing
the mucosal defense
Antacids
Mechanism Of Action
Available Brands
• Gaviscon, Tricil, Aluphagel, Magalcid
a. Drugs enhancing
the mucosal defense
Prostaglandin analogues
• Misoprostol is a prostaglandin
analogue that promotes ulcer healing
by stimulating mucus and
bicarbonate secretion and inhibition
of acid secretion.
b. Acid Suppression
Drugs
• H2 receptor antagonists
• Cimetidine
Dose 400 mg BD or 800 mg at night
Available Brands Cimet , Tagamet, Ulcerex
• Ranitidine
Dose 150 mg BD or 300 mg at night
Available Brands Zantac, Anzol, Renulcid,
Ranax
• Famotidine
Dose 20 mg BD or 40 mg at night
Available Brands Famopsin, Polypep, Nocid,
Peptiban
Proton Pump Inhibitors
Mechanism Of Action
They bind with the acid secreting
enzyme called H+ K+ ATPase (Proton
Pump) and inactivate it, thereby
inhibiting acid secretion. The PPIs
inhibit approximately 90 – 95% of
acid production.
Proton Pump Inhibitors
Major Drugs Available
• Omeprazole
Dose 20 mg OD
Available Brands Risek, Omega , Ruling, Omezol
• Lansoprazole
Dose30 mg OD
Available Brands Selanz, Inhibitol, lanzac
• Pantoprazole
Dose40 mg OD
Available Brands Zotonix, Zopent, Protium, Pantazol
• Esomeprazole
Dose20 – 40 mg OD
Available Brands Espra, Esopra, Nexium, Esso
• Rebprazole
Dose10-20 mg OD
Available Brands Bepra, Rabicid, Zechin, Prompto