Hi. Welcome to our video
on peptic ulcer disease.
Now, I wanna make sure you're very focused
because this next question is incredibly complex.
So I may need you to pay
intense attention, okay?
So are you ready for this?
I'm gonna come up with a question, I need
you to be very quiet in your environment
and really pay attention to the wording.
What does frosting a hot cupcake and
your stomach lining have in common?
Okay, I know that was a weird
question but let me tell you.
I promise we really have
a meaning here.
Now even if you didn't come up with anything,
frankly I'd be kinda amazed if you did.
But here's what I want you to think about.
If you haven't tried to frost a hot cupcake,
I wanna explain to you what happens.
If you've ever been like late for
something and you make a cake or cupcake
and you need to get the frosting on it and
you take it and the cake is still hot.
As you spread the frosting, big chunks of the
cake lining keep coming up in the frosting.
So it's kind of like your stomach lining.
See, the purpose of frosting is to cover the cake
and to protect it, to keep it from getting stale.
Same thing works on your stomach lining.
The lining of your stomach is very sensitive and
fragile, much like that cupcake that's still too warm.
So we need to frost or coat
the inside of your stomach.
Now what the inside of your stomach is frosted
or coated with is this really thick mucus.
So I want you to keep this in mind.
So draw your version of what
a stomach would look like.
So use one color to draw a version
of your stomach
then I want you to draw what looks like to you mucus,
all the way around in that stomach - a coating.
So you got that coating, now part of what
keeps that mucus really effective,
it's kind of that thick gel mucus in your stomach
but it also has things called bicarbonate.
Cool part about bicarbonate is
it neutralizes and it protects
your stomach lining - that really
fragile lining, from the gastric acid.
So take a look at your drawing.
If you're thinking about this, you
should have a drawing of a stomach,
you have some mucus coating all the
way around the inside of your stomach
and I then I want you to put just some little
dots to remind you that that mucus
is full of bicarbonate which
neutralizes gastric acid.
Now, don't forget to draw some gastric
acid in there so you can remember
that we obviously have gastric acid in our
stomach that helps to break down food.
Now, why would we take
the time to draw this?
Because here's what I want you to start thinking
about before we get in to the rest of the video.
Peptic ulcer disease means that you have
like a small erosion on your stomach.
It's an open sores that
develop on the stomach lining
because that stomach lining somehow
gets exposed to that gastric acid.
So it can happen either on your stomach
lining or your small intestine.
Now again, debbie downer here, the worst
case scenario that can happen is that,
that can lead to a
perforation and a GI bleed.
That means that that open sore can
become worse and worse and worse,
work its way all the way through the stomach
lining 'til we call that a perforation.
Once you have that perforation,
now your'e risking GI bleeding.
Meaning there's gonna be lots of
blood leaving from that wound
and ding to your gut cavity and now we've got
a really big problem with your patient.
GI bleeds could be severe and lead to
shock and even bigger problems.
So, we wanna make sure that we
stop peptic ulcer disease earlier.
Now, back to your drawing.
Take a look at that and I want you
to see this picture up here on the screen.
See how we have that sore?
that's what peptic ulcer disease is.
Now hopefully you can remember that
you have it in a couple of places.
It can be in your stomach or the
small intestine in the duodenum.
So those are the places when we say peptic ulcer
disease that you're most likely to see these wounds.
Now see how being kind of deep into the
different layers of your stomach lining.
Now before we talk about the drugs together,
I want you to think like an engineer.
You know, they're amazing problem solvers.
So, we say that we have this problem, right?
We have these sores.
What are some things that we could do to help
kind of prevent or to treat peptic ulcer disease?
Well, the problem is, we have
this gastric acid stuff.
So, a simple over the counter
medication that might help us with acid
is that we could use an antacid, right?
So you know those by their trade names
like Tums, or something like that.
We use those as antacids that'll
actually neutralize that acid.
That's one way to treat it but
it's really not the most effective.
Maybe we could use something
that would slow down
the amount of gastric acid in the stomach.
Ah, now that sounds better.
So we've got a couple of choices
when it comes to medications
that will make less gastric acid
available in our bodies.
They're called H2-antagonist
or proton pump inhibitors.
Okay, so we can either neutralize the acid
that we have or make less acid available.
There's some couple of ways we can do it.
We can also put like a liquid bandage
or a little band-aid
on that booboo, on that sore that
you have in your stomach lining.
They can use the medications that are
like sucralfate, that are super sticky.
Your patient swallows them by
mouth, they go down to the GI tract
and they... they will stick right
to that sore just like a band-aid.
So before we start talking about the drugs, I want
you just to kinda have in mind what are we treating.
We're treating these wounds,
these sores in the stomach.
We wanna deal with that gastric
acid because that's what started
the wound or that sore
in peptic ulcer disease.
And so we wanna help it heal.
We've got to protect it from
more of the gastric acid.
We wanna neutralize the acid and
just have less acid available.
Okay, that's your introduction.
Now, let's start taking a look at as we
walk through each of these concepts.
This next slide is gonna layout those
things that you want to keep in mind
when we're thinking about
peptic ulcer disease.
So you guess.
Yeah, that's kind of a fun word to
say but it's the cells in the mucosa
and it coats the lining of the stomach.
So that's really good.
This is how the body normally
keeps my stomach protected.
First thing, I need to have plenty of mucus
available to coat the entire lining of my stomach.
Next we talk about that bicarbonate.
Now that's secreted by the
epithelial cells of your GI tract
and that's what neutralizes
the gastric acid.
So mucus has to be there but it needs
to have lots of bicarbonate in it
so it will neutralize gastric acid.
So the first two ways, we're talking
about how the body naturally protects
that stomach lining is plenty of mucus and then
bicarbonate that will help neutralize the acid.
Now just like anything else, you
have to have really good blood flow.
Otherwise, you won't have adequate
levels of mucus to completely coat
the inside of the stomach and adequate levels
of bicarbonate to neutralize the acid.
And finally, prostaglandins are what stimulate
the mucus and the bicarbonate secretions.
So, all four of these things
So if my patient is having a problem, it might
be a blood flow issue but more often than not,
we've got some challenges with the amount
of bicarbonate or mucus that are available
or maybe the initial problem is starting
from prostaglandins being supressed.
There's some of the medications
that suppress the prostaglandins
(Non Steroidal Anti-Inflammatories).
So the most important point here, I'd
like you to number those: 1, 2, 3 and 4
because I want you to get your brain to recognize
that all four of these things need to be healthy.
I'm almost, in healthy amounts because I
want you to almost think of it as a scale.
If I have... if I'm under attack then we'll talk
about what attacks your body in just a minute.
But if I'm under attack by a thing
we call H-pylori - that's a bug,
if I'm under attack by H-pylori, if I have
adequate amounts of mucus, bicarbonate,
good blood flow and lots of prostaglandins,
hopefully I can fight that off.
But if I don't, if the bug gets stronger, then
the ability I have to defend my stomach lining
then I'm gonna end up
with peptic ulcer disease.