Download - Ulcera peptica
![Page 1: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/1.jpg)
DR. JUAN CAPCHA RAMIREZ
![Page 2: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/2.jpg)
ULCERA PÉPTICA
Definición: solución de continuidad de la mucosa que alcanza hasta la submucosa
Problema médico importante:Frecuencia, síntomas, complicacionesAprox 10% población Alto impacto en costos de salud
![Page 3: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/3.jpg)
![Page 4: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/4.jpg)
FACTORES DEFENSIVOS FACTORES AGRESIVOS
MUCUS PEPSINA
BICARBONATO ÁCIDO CLORHÍDRICO
CAPA DE FOSFOLÍPIDOS HELICOBACTER PYLORI
RECAMBIO CELULAR AINES Y AAS
ANGIOGÉNESIS Y FLUJO SANGUÍNEO
ESTRÉS FISIOLÓGICO
PROSTAGLANDINAS TABACO Y ALCOHOL
FACTORES DE CRECIMIENTO SALES BILIARES
Fisiopatología de la ulcera péptica
![Page 5: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/5.jpg)
MECANISMOS DE DEFENSA Y CICATRIZACION
![Page 6: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/6.jpg)
![Page 7: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/7.jpg)
ETIOPATOGENIA DE LA ULCERA PEPTICA
![Page 8: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/8.jpg)
![Page 9: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/9.jpg)
TABACO Y ULCERA PEPTICA
![Page 10: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/10.jpg)
![Page 11: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/11.jpg)
240 ml 350ml
![Page 12: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/12.jpg)
MECANISMOS ALTERADOS EN LA UG
![Page 13: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/13.jpg)
SECRECION GASTRICA Y UD
![Page 14: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/14.jpg)
REGULACION DEL FLUJO SANGUINEO GASTRICO
1.-SISTEMA NERVIOSO CENTRAL:
HIPOTALAMO ANTERIOR: FSG Y SECRECION ACIDA
HIPOTALAMO POSTERIOR: FCG Y SECRECION ACIDA
2.-SISTEMA NERVIOSO AUTONOMO:
SIMPATICO:DESCENSO FSG
PARASIMPATICO:INCREMENTO FSG
3.- ADENOSINA: VASODILATACION
4.- HORMONAS:
-GASTRINA: INCREMENTA
-VASOPRESINA: VASOCONSTRICCION
-SOMATOSTATINA:VASOCONSTRICCION
SECRETINA:VASODILATACION
-CCK:VASODILATADOR
![Page 15: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/15.jpg)
5.PROSTAGLANDINAS:VASODILATACION
6.-TOMBOXANOS Y LEUCOTRIENOS:VASOCONSTRICCION
7.- NEUROPEPTIDOS:
CGRP.VIP
8.- ENDOTELINAS:VASOCONSTRICCION
REGULACION DEL FLUJO SANGUINEO GASTRICO
![Page 16: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/16.jpg)
Secrecion basal y estimulada
![Page 17: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/17.jpg)
ALTERACIONES DE LA SECRECION ACIDA
![Page 18: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/18.jpg)
GASTRINA POSTPRANDIAL
![Page 19: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/19.jpg)
Sensibilidad de celulas parietales a pentagastrina
![Page 20: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/20.jpg)
Mecanismos de defensa defectuosos
![Page 21: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/21.jpg)
![Page 22: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/22.jpg)
SECRECION DE ACIDO
![Page 23: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/23.jpg)
![Page 24: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/24.jpg)
CICATRIZACION Y PEPSINA
![Page 25: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/25.jpg)
![Page 26: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/26.jpg)
FACTORES DE RIESGO DE LA ÚLCERA DE STRESS
- Cirugía mayor - Shock hemorrágico - Hipotensión - Ventilación mecánica prolongada - Coagulopatía - Trauma - Sepsis - Grandes quemados ( >35%, úlcera de Curling ) - Enf. graves del SNC ( úlcera de Cushing ) - Enf. graves ( hepáticas, renales, respiratorias...)
![Page 27: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/27.jpg)
ROTURA DE LA BARRERA MUCOSA
RETRODIFUSION H+
NORMOTENSION NORMOTENSIONSHOCK
FSG NORMALFSG INADECUADO
FSG
DISMINUIDOS
OXIGENACION Y PHANOXIA TISULAR Y ACIDOSIS LEVE
ANOXIA ACIDOSIS SEVERA
SIN LESION DE MUCOSA
LESION EN MUCOSA LESION GRAVE
![Page 28: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/28.jpg)
![Page 29: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/29.jpg)
![Page 30: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/30.jpg)
![Page 31: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/31.jpg)
CITOXINA VACUOLIZANTE
VACUOLES EN CELULAS EPITELIALES
UREASA
Helicobacter pylori
MUCINASA
ION AMONIO
DAÑO MUCINOSO
LIPASA
FOSFOLIPASA
FACTORES QUIMIOTACTICOS...IL-1,TNF
ADEHERENCIA AL ENDOTELIO Y EXTRAVASACION DE LEUCITOS
INFLAMACION
ROTURA DE BARREARA MUCOSA GASTRICA
DAÑO EPITELIAL
PAF
LIPOLISACARIDO
INHIBICION DE LA UNION LAMININA-RECEPTOR
HIPERGASTRINEMIA
CELULAS PARIETALES
SECRECION ACIDO
![Page 32: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/32.jpg)
![Page 33: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/33.jpg)
![Page 34: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/34.jpg)
INFECCION AGUDA HIPOCLORHIDRIA
LESION TOXICA DIRECTA SOBRE
CELULA PARIETAL
INFECCION CRONICA
SOMATOSTANIA ANTRAL
HIPERGASTRINEMIA
HIPERCLORHIDRIA
![Page 35: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/35.jpg)
FACTORES AMBIENTALES
GASTRITIS AGUDA GASTRITIS CRONICA ACTIVA
GASTRITIS ATROFICA MULTIFOCAL
ULCERA GASTRICA
H.PYLORI
![Page 36: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/36.jpg)
>Gastrina>Gastrina<Somatostatina<Somatostatina
SECRECION ACIDOPEPTICA
SECRECION DE HCO3
METAPLASIA GASTRICA EN DUODENO
H.PYLORI DUODENITISULCERA DUODENAL
![Page 37: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/37.jpg)
![Page 38: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/38.jpg)
![Page 39: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/39.jpg)
What are the effects of H pylori on the stomach? (Reviews by Thomas)
H pylori increase odds of stomach cancer by 2.1 to 16.7 in various studies (average 5.9)
3% of individuals with H pylori progress to gastric cancer
in distal gastric cancer progression over 30 years is:
chronic superficial gastritis
atrophic gastritis
intestinal metaplasia
dysplasia
![Page 40: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/40.jpg)
COX-1- COX-2REGULACION CONSTITUTIVA INDUCIBLE
RANGO DE EXPRESION 2-4 VECES 10-80 VECES
TEJIDOS PLAQUETAS,ENDOTE-LIO,ESTOMAGO,RIÑONMUSCULO LISO,ETC.
PROSTATA TESTICULOS,CEREBRO,SINOVIOCITOS,FOLICULOS OVARICOS
GLUCOCORTICOIDES NINGUNO INHIBE TOTALMENTE
ENZIMA PGS. NORMALES PGS INFLAMACION,CRECIMIENTO CELULAR Y OVULACION
![Page 41: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/41.jpg)
![Page 42: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/42.jpg)
![Page 43: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/43.jpg)
AA
COX.1 COX-2
GLUCOCORTICOIDES
ENDOTOXINASCITOCINAS MITOGENOS
INHIBIDORES COX-2
ESTOMAGO RIÑON INTESTINO PLAQUETAS
INHIBIDORES NO SELECTIVOS
TEJIDOS INFLAMATORRIOSMACROFAGOS SINOVIOCITOS
(-)
![Page 44: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/44.jpg)
MECANISMOS PATOGENICOS DE LOS AINESACCION DIRECTA
- ACUMULACIÓN INTRACELULAR
ATRAPAMIENTO IONICO
RETRODIFUSION DE HIDROGENIONES
INHIBICION DE FOSFORILACION OXIDATIVA Y TRANSPORTE IONICO ESTIMULACION DE ACIDO-PEPSINA
ACCION INDIRECTA
PRE-EPITELIAL
SECRECION DE MOCO Y VIDCOCIDAD
FOSFOLIPIDOS TENSOACTIVO
HIDROFOBICIDAD DE MUCOSA
SECRECION HCO3
EPITELIAL
REDUCCION DE PROLIFERACION CELULAR
INHIBICION FACTOR DE CRECIMIENTO PLAQUETARIO
POT-EPITELIAL:
FLUJOI VASCULAR
OXIRADICALES Y LEUCOTRIENOS
LESION ENDOTELIAL POR ADHESION LEUCOCITAria
![Page 45: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/45.jpg)
![Page 46: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/46.jpg)
FACTORES AGRESIVOS LUMINALES:1.-IRRITANTES LOCALES:LIBERAN: LEUCOTRIENOS B4 Y C4ACTIVACION DE FOSFOLIPASA Y FAP2.-DIFERENCIA DE POTENCIAL TRANSMUCOSO.ASA,SALES BILIARES Y ETANOL:DISMINUYEN LA DIFERENCIADE POTENCIAL ELECTRICO
FACTORES AGRESIVOS INTRAMUCOSOS:1.-RADICALES LIBRES DE OXIGENO:ISQUEMIA-REPERFUSION: ACTIVAN LA XANTINA OXIDASACELULAS ENDOTELIALES PRINCIPAL PRODUCTOR DE RLO.2.- TROMBOXANO A: VASOCONSTRICTOR EFECTO CITOLITICO DIRECTO3.- FAP: DISMINUYE FLUJO SANGUINEO GASTRICOAUMENTA PERMEABILIDAD VASCULARINDUCE LIBERACION DE RLO.LIBERACION ENZIMAS LISOSOMALES.4.- LEUCOTRIENOS C4 EFECTO VASOCONSTRICTOR5.-LEUCOTRIENOS B4. QUIMIOTAXIS DE LEUCOCITOS
![Page 47: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/47.jpg)
![Page 48: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/48.jpg)
![Page 49: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/49.jpg)
![Page 50: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/50.jpg)
![Page 51: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/51.jpg)
![Page 52: Ulcera peptica](https://reader036.vdocuments.co/reader036/viewer/2022062320/559066871a28ab8e638b46b1/html5/thumbnails/52.jpg)