SHAFIRA MEDINA 130110110030 1 Pathogenesis Of Peptic Ulcer related to the Case and Side Effect Diclofenac

PEPTIC ULCER Stomach ulcer is a hole in the lining of the stomach, duodenum (duodenum), or esophagus. Stomach ulcers (peptic ulcers) of the stomach is called gastric ulcer; of the duodenum, duodenal ulcer, and of the esophagus, esophageal ulcers. Peptic ulcers are produced by an imbalance between the gastroduodenal mucosal defense mechanisms and damaging forces of gastric acid and pepsin, combined with superimposed injury from environmental or immunologic agents. Mechanism The main cause of ulcers is now believed is an infection of the stomach by bacteria called "Helicobacter pyloridus" (H. pylori). H. pylori secretes urease (generates ammonia), protease (breaks down glycoprotein in the gastric mucus) or phospholipases. Bacterial lipopolysaccharide attracts inflammmatory cells to the mucosa. Neutrophils release myeloperoxide. A bacterial platelet-activating factor promotes thrombotic occlusion of surface capillaries. Mucosal damage allows leakage of tissue nutrients in the surface microenvironment , sustaining the bacillus. Damage of the protective mucosal layer. The epithelial cells are exposed to the damaging effect of acid-peptic digestion. Inflammation of the gastric mucosa. Chronically inflamed mucosa more susceptible to acid- peptic injury and prone to peptic ulceration. Ulcers occur at sites of chronic inflammation . Eg - Antrum , Junction of antral and body- fundic mucosa (division between the inflamed antral mucosa and normal acid secreting mucosa). Pangastritis - When there is extensive gastritis, the ulcers are more proximally situated. In elderly patients gastric ulcers are more proximally situated as there is proximal migration of the antral-body mucosal junction. Symtoms of Ulcer Disease The symptoms of ulcer disease is diverse. Many ulcer patients experience indigestion (indigestion) or no discomfort at all. Some report a burning sensation in the upper abdomen or hunger pain one to three hours after eating and the middle of the night. Pain symptoms are often promptly relieved by food or antacids. The pain of ulcer disease correlates poorly with the presence or severity of active ulceration. Some patients have persistent pain even after the ulcers healed completely with treatment. Others do not experience any pain at all, though ulcers return. Ulcers often come and go spontaneously without ever being known by that individual, except for serious complications (such as bleeding or perforation) occurs. The complications of ulcers Patients with ulcers generally function quite comfortably. Some of the ulcers healed possible even without medications. Therefore, the main problems resulting from ulcers associated with ulcer complications. Complications including bleeding ulcers, ulcer perforation, and gastric barrier. Patients with bleeding ulcers may report the stool black tarry-stool (melena), weakness, feeling faint when standing (orthostatic syncope), and vomited blood (hematemesis). Initial treatment involves rapid replacement of lost body fluids intravenously. Patients with persistent or severe bleeding may require blood transfusions. Upper endoscopy done to enforce the bleeding and to stop active bleeding ulcers with the help of the tools are heated. Other factors causing peptic ulcer Peptic ulcer caused due to high gastrin level and excess acid production. Gastrinoma may cause multiple peptic ulceration as in Zollinger Ellison syndrome. There is increased parietal cell mass. Peptic ulcers caused due to impaired mucosal defense . The gastric acid and pepsin levels are normal and no H.pylori are present. Chronic use of NSAIDs (aspirin) causes suppression of

SHAFIRA MEDINA 130110110030 2 Pathogenesis Of Peptic Ulcer related to the Case and Side Effect Diclofenac
mucosal prostaglandin and direct irritative topical effect. Repeated use of corticosteroid in high dose. Cigarette smoking impair healing and favour recurrences. Alcoholic cirrhosis. Personality, psychological stress, ischemia. Aspirin (eg Disprin) and non-steroidal anti-inflammatory drugs (NSAIDs such as diclofenac or naproxen) can cause ulcers, but only a small proportion of the people taking these drugs develop an ulcer. However, because they are so widely used, hundreds of people in the UK die each year as a result of ulcer complications associated with these drugs. Some people have a very high sensitivity to aspirin and NSAIDs and such people should not take this sort of medication. About diclofenac Type of medicine Used for Non-steroidal anti-inflammatory drug (NSAID) Pain and inflammation in rheumatic disease, and in disorders of the joints, muscles and tendons Gout Pain relief after operations Diclofenac sodium, Diclofenac potassium, Voltarol, Voltarol SR, Voltarol Retard, Voltarol Rapid Diclomax SR, Diclomax Retard Motifene, Defenac, Diclofex, Dyloject, Flamrase, Flamatak, Econac, Rhumalgan SR, Rhumalgan XL, Volsaid SR A substance in the body called cyclo-oxygenase (COX) is involved in the production of various chemicals in the body, including prostaglandins. Prostaglandins are produced in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Diclofenac blocks the action of COX, so stopping the production of these prostaglandins. This results in less pain, swelling and inflammation. Risk from treatment with aspirin (acetylsalicylic acid) and NSAIDs People older than 60 - the risk increases with age. If you have had a previous ulcer, the risk is high. If you are taking anticoagulants (blood-thinning treatment) at the same time, bleeding is more likely and more serious when it occurs. Oral corticosteriods (such as prednisolone (eg Precortisyl)) increase the chances of gastric irritation and ulcers. The larger the dose of aspirin or NSAIDs the greater the risk. The longer duration of the treatment, the greater the risk.

Diclofenac may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: diarrhea constipation gas or bloating headache dizziness ringing in the ears

Also called

Tablets and dispersible tablets Enteric coated tablets (coated to make sure the diclofenac is released after the tablet has passed through the stomach. This protects the stomach) Available as Modified release tablets and capsules (diclofenac released slowly for a more even effect) Suppositories Injection Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation.

SHAFIRA MEDINA 130110110030 3 Pathogenesis Of Peptic Ulcer related to the Case and Side Effect Diclofenac
Some side effects can be serious. If you experience any of the following symptoms or those mentioned in the IMPORTANT WARNING section, call your doctor immediately. Do not take any more diclofenac until you speak to your doctor. unexplained weight gain excessive tiredness lack of energy nausea loss of appetite itching pain in the upper right part of the stomach yellowing of the skin or eyes flu-like symptoms fever blisters rash hives swelling of the eyes, face, tongue, lips, throat, arms, hands, feet, ankles, or lower legs difficulty breathing or swallowing hoarseness pale skin fast heartbeat cloudy, discolored, or bloody urine back pain difficult or painful urination

Diclofenac may cause other side effects