!
طب بـاط
ـرةICU
ـاضـرة ا*ـاش-ا
Peptic ulcers
!م#يةا01)(حـة اا'&ة#ا
ـر3ا
ة+ا-ة ا.ا/ا
BCS. anesthesia and ICU
Karrar Nader AL-Taie 45 6.د
The Stomach ا<عـ ّدة
it is a muscular, hollow organ in the gastrointestinal tract of humans, The
stomach has a dilated structure and functions as digestive organ, It performs
a chemical breakdown by means of enzymes and hydrochloric acid. the
stomach is located between the esophagus and the small intestine. Stomach
divided into four regions
، اﻟﻤﻌﺪة ﻟﮭﺎ ﺑﻨﯿﺔ ﻣﺘﻮﺳﻌﺔ وﺗﻌﻤﻞ ﻛﺠﮭﺎز ھﻀﻤﻲ،إﻧﮫ ﻋﻀﻮ ﻋﻀﻠﻲ ﻣﺠﻮف ﻓﻲ اﻟﺠﮭﺎز اﻟﮭﻀﻤﻲ ﻟﻠﺒﺸﺮ
ﺗﻘﻊ اﻟﻤﻌﺪة ﺑﯿﻦ اﻟﻤﺮيء.وﺗﺆدي اﻧﮭﯿﺎرا ﻛﯿﻤﯿﺎﺋﯿﺎ ﻋﻦ طﺮﯾﻖ اﻹﻧﺰﯾﻤﺎت وﺣﻤﺾ اﻟﮭﯿﺪروﻛﻠﻮرﯾﻚ
. اﻟﻤﻌﺪة ﻣﻘﺴﻤﺔ إﻟﻰ أرﺑﻊ ﻣﻨﺎطﻖ.واﻷﻣﻌﺎء اﻟﺪﻗﯿﻘﺔ
The cardia, The fundus , The body , The pylorus
وا?واب، BC وا، اع3 وا، لب3ا
The stomach is much like a bag with a lining. The stomach is made of these
4 layers: : اﻟﻤﻌﺪة ﻣﺼﻨﻮﻋﺔ ﻣﻦ ھﺬه اﻟﻄﺒﻘﺎت اﻷرﺑﻊ.ﺗﺸﺒﮫ اﻟﻤﻌﺪة إﻟﻰ ﺣﺪ ﻛﺒﯿﺮ ﺣﻘﯿﺒﺔ ذات ﺑﻄﺎﻧﺔ
• Mucosa. This is the first layer or lining. It contains the glands that release
digestive juices. These are called hydrochloric acid and pepsin. This is
where most stomach cancers start.
ﯾﺤﺘﻮي ﻋﻠﻰ اﻟﻐﺪد اﻟﺘﻲ ﺗﻄﻠﻖ اﻟﻌﺼﺎﺋﺮ. ھﺬه ھﻲ اﻟﻄﺒﻘﺔ اﻷوﻟﻰ أو اﻟﺒﻄﺎﻧﺔ.اﻟﻐﺸﺎء اﻟﻤﺨﺎطﻲ
ھﺬا ھﻮ اﻟﻤﻜﺎن اﻟﺬي ﺗﺒﺪأ ﻓﯿﮫ ﻣﻌﻈﻢ. ﺗﺴﻤﻰ ھﺬه اﻷﺣﻤﺎض اﻟﮭﯿﺪروﻛﻠﻮرﯾﻚ واﻟﺒﯿﺒﺴﯿﻦ.اﻟﮭﻀﻤﯿﺔ
.ﺳﺮطﺎﻧﺎت اﻟﻤﻌﺪة
• Submucosa. This second layer supports the mucosa. It is rich in blood
vessels, lymphatic vessels, and nerves.
إﻧﮫ ﻏﻨﻲ ﺑﺎﻷوﻋﯿﺔ اﻟﺪﻣﻮﯾﺔ واﻷوﻋﯿﺔ. ﺗﺪﻋﻢ ھﺬه اﻟﻄﺒﻘﺔ اﻟﺜﺎﻧﯿﺔ اﻟﻐﺸﺎء اﻟﻤﺨﺎطﻲ.ﺗﺤﺖ اﻟﻤﻮﻛﻮزا
.اﻟﻠﻤﻔﺎوﯾﺔ واﻷﻋﺼﺎب
• Muscularis. The third layer is made of thick muscles. They help to mix
food with the digestive juices.
إﻧﮭﺎ ﺗﺴﺎﻋﺪ ﻋﻠﻰ ﺧﻠﻂ اﻟﻄﻌﺎم ﻣﻊ اﻟﻌﺼﺎﺋﺮ. اﻟﻄﺒﻘﺔ اﻟﺜﺎﻟﺜﺔ ﻣﺼﻨﻮﻋﺔ ﻣﻦ ﻋﻀﻼت ﺳﻤﯿﻜﺔ..اﻟﻌﻀﻼت
.اﻟﮭﻀﻤﯿﺔ
• Serosa. This is the last and outermost layer. It’s the lining that wraps
around the stomach to confine it.
إﻧﮭﺎ اﻟﺒﻄﺎﻧﺔ اﻟﺘﻲ ﺗﻠﺘﻒ ﺣﻮل اﻟﻤﻌﺪة. ھﺬه ھﻲ اﻟﻄﺒﻘﺔ اﻷﺧﯿﺮة واﻟﺨﺎرﺟﯿﺔ.ﺳﯿﺮوﺳﺎ
.ﻟﺤﺼﺮھﺎ
The Duodenum F عH Iا
the most proximal portion of the small intestine, forms a C-shaped loop
around the head of the pancreas and is in continuity with the pylorus
proximally and the jejunum it is divided into four parts
ﺣﻮل رأس اﻟﺒﻨﻜﺮﯾﺎسC ﯾﺸﻜﻞ ﺣﻠﻘﺔ ﻋﻠﻰ ﺷﻜﻞ ﺣﺮف، اﻟﺠﺰء اﻷﻗﺮب ﻣﻦ اﻷﻣﻌﺎء اﻟﺪﻗﯿﻘﺔ
وﯾﺘﻮاﺻﻞ ﻣﻊ اﻟﺒﻮاب اﻟﻘﺮﯾﺐ واﻟﺼﺎﺋﻢ وﯾﻨﻘﺴﻢ إﻟﻰ أرﺑﻌﺔ أﺟﺰاء
The duodenal bulb, about 2 cm long, is the first part of the duodenum and
is slightly dilated. Then the second ,third and fourth segments.
ھﻲ اﻟﺠﺰء اﻷول ﻣﻦ اﻻﺛﻨﻲ ﻋﺸﺮ وھﻲ، ﺳﻢ2 اﻟﺘﻲ ﯾﺒﻠﻎ طﻮﻟﮭﺎ ﺣﻮاﻟﻲ، اﻟﺒﺼﻠﺔ اﻻﺛﻨﻲ ﻋﺸﺮﯾﺔ
. ﺛﻢ اﻟﻤﻘﺎطﻊ اﻟﺜﺎﻧﯿﺔ واﻟﺜﺎﻟﺜﺔ واﻟﺮاﺑﻌﺔ.ًﻣﺘﻮﺳﻌﺔ ﻗﻠﯿﻼ
The wall of the duodenum also devided like the stomach to mucosa,
submucosa, muscularis, and serosa layers
ﯾﻨﻘﺴﻢ ﺟﺪار اﻻﺛﻨﻲ ﻋﺸﺮ أﯾﻀًﺎ ﻣﺜﻞ اﻟﻤﻌﺪة إﻟﻰ طﺒﻘﺎت اﻟﻐﺸﺎء اﻟﻤﺨﺎطﻲ وﺗﺤﺖ اﻟﻤﺨﺎطﻲ واﻟﻌﻀﻠﻲ
واﻟﻄﺒﻘﺎت اﻟﻤﺼﻠﯿﺔ
Gastroduodenal Mucosal Secretions and Protective Factors
إﻓﺮازات اﻟﻐﺸﺎء اﻟﻤﺨﺎطﻲ اﻟﻤﻌﺪي اﻟﻜﻠﻮي وﻋﻮاﻣﻞ اﻟﺤﻤﺎﯾﺔ
hydrochloric acid (HCl) is the primary gastric secretion, the stomach also
secretes water, electrolytes (hydrogen [H+], sodium [Na+], potassium
[K+], chloride [Cl-], and bicarbonate [HCO3]), enzymes (pepsin and
gastric lipase), and glycoproteins (intrinsic factors and mucin) to assist in
a wide variety of physiologic functions.
واﻟﻜﮭﺎرل، وﺗﻔﺮز اﻟﻤﻌﺪة أﯾﻀًﺎ اﻟﻤﺎء، ( ھﻮ إﻓﺮاز اﻟﻤﻌﺪة اﻷﺳﺎﺳﻲHCl) ﺣﻤﺾ اﻟﮭﯿﺪروﻛﻠﻮرﯾﻚ
، [-Cl] واﻟﻜﻠﻮرﯾﺪ، [+ K] واﻟﺒﻮﺗﺎﺳﯿﻮم، [+ Na] واﻟﺼﻮدﯾﻮم، [+ H] )اﻟﮭﯿﺪروﺟﯿﻦ
واﻹﻧﺰﯾﻤﺎت )اﻟﺒﯿﺒﺴﯿﻦ وﻟﯿﺒﺎز اﻟﻤﻌﺪة( واﻟﺒﺮوﺗﯿﻨﺎت اﻟﺴﻜﺮﯾﺔ )اﻟﻌﻮاﻣﻞ، ([HCO3] وﺑﯿﻜﺮﺑﻮﻧﺎت
.اﻟﺪاﺧﻠﯿﺔ واﻟﻤﻮﺳﯿﻦ( ﻟﻠﻤﺴﺎﻋﺪة ﻓﻲ ﻣﺠﻤﻮﻋﺔ ﻣﺘﻨﻮﻋﺔ ﻣﻦ اﻟﻮظﺎﺋﻒ اﻟﻔﺴﯿﻮﻟﻮﺟﯿﺔ
The Mucosal Barrier JاK اLاMا
The mucosa of the stomach and duodenum is exposed to the digestive
effect of gastric acid. Gastric enzymes that can digest protein can also
digest the stomach itself. The stomach is protected from self-digestion by
the mucosal barrier. This barrier has several components.
إﻧﺰﯾﻤﺎت اﻟﻤﻌﺪة.ﯾﺘﻌﺮض اﻟﻐﺸﺎء اﻟﻤﺨﺎطﻲ ﻟﻠﻤﻌﺪة واﻻﺛﻨﻲ ﻋﺸﺮ ﻟﻠﺘﺄﺛﯿﺮ اﻟﮭﻀﻤﻲ ﻟﺤﻤﺾ اﻟﻤﻌﺪة
اﻟﻤﻌﺪة ﻣﺤﻤﯿﺔ ﻣﻦ اﻟﮭﻀﻢ اﻟﺬاﺗﻲ.اﻟﺘﻲ ﯾﻤﻜﻨﮭﺎ ھﻀﻢ اﻟﺒﺮوﺗﯿﻦ ﯾﻤﻜﻨﮭﺎ أﯾﻀًﺎ ھﻀﻢ اﻟﻤﻌﺪة ﻧﻔﺴﮭﺎ
. ھﺬا اﻟﺤﺎﺟﺰ ﻟﮫ ﻋﺪة ﻣﻜﻮﻧﺎت.ﺑﻮاﺳﻄﺔ اﻟﺤﺎﺟﺰ اﻟﻤﺨﺎطﻲ
First, the stomach wall is covered by a thick coating of mucus that is
bicarbonate- rich to neutralize acid.
. ﯾُﻐﻄﻰ ﺟﺪار اﻟﻤﻌﺪة ﺑﻄﺒﻘﺔ ﺳﻤﯿﻜﺔ ﻣﻦ اﻟﻤﺨﺎط اﻟﻐﻨﻲ ﺑﺎﻟﺒﯿﻜﺮﺑﻮﻧﺎت ﻟﻤﻌﺎدﻟﺔ اﻟﺤﻤﺾ، ًأوﻻ
Second, the epithelial cells of the stomach’s mucosa meet at tight
junctions, which block gastric acid from penetrating the underlying
tissue layers.
واﻟﺘﻲ، ﺗﻠﺘﻘﻲ اﻟﺨﻼﯾﺎ اﻟﻈﮭﺎرﯾﺔ ﻓﻲ اﻟﻐﺸﺎء اﻟﻤﺨﺎطﻲ ﻟﻠﻤﻌﺪة ﻋﻨﺪ اﻟﺘﻘﺎطﻌﺎت اﻟﻀﯿﻘﺔ، ﺛﺎﻧﯿًﺎ
.ﺗﻤﻨﻊ ﺣﻤﺾ اﻟﻤﻌﺪة ﻣﻦ اﺧﺘﺮاق طﺒﻘﺎت اﻷﻧﺴﺠﺔ اﻷﺳﺎﺳﯿﺔ
third, stem cells quickly replace damaged epithelial mucosal cells, when
the epithelial cells are shed. the surface epithelium of the stomach is
completely replaced every 3 to 6 days.
ﻋﻨﺪﻣﺎ ﯾﺘﻢ اﻟﺘﺨﻠﺺ ﻣﻦ، ﺗﺴﺘﺒﺪل اﻟﺨﻼﯾﺎ اﻟﺠﺬﻋﯿﺔ ﺑﺴﺮﻋﺔ اﻟﺨﻼﯾﺎ اﻟﻤﺨﺎطﯿﺔ اﻟﻈﮭﺎرﯾﺔ اﻟﺘﺎﻟﻔﺔ، ﺛﺎﻟﺜًﺎ
. أﯾﺎم6 إﻟﻰ3 ﯾﺘﻢ اﺳﺘﺒﺪال ظﮭﺎرة اﻟﻤﻌﺪة اﻟﺴﻄﺤﯿﺔ ﺗﻤﺎ ًﻣﺎ ﻛﻞ.اﻟﺨﻼﯾﺎ اﻟﻈﮭﺎرﯾﺔ
Physiology of mucosal barrier JاK اLاMا اNOيوP
The mucosa are maintained through micro vascular supply through which
tissues and glands are functions, microvasclar (capillary) patency are
maintained through prostaglandins that helps in following actions
ﯾﺘﻢ اﻟﺤﻔﺎظ ﻋﻠﻰ اﻟﻐﺸﺎء اﻟﻤﺨﺎطﻲ ﻣﻦ ﺧﻼل إﻣﺪاد اﻷوﻋﯿﺔ اﻟﺪﻣﻮﯾﺔ اﻟﺪﻗﯿﻘﺔ اﻟﺬي ﺗﻌﻤﻞ ﻣﻦ ﺧﻼﻟﮫ
)اﻟﺸﻌﯿﺮات اﻟﺪﻣﻮﯾﺔ( ﻣﻦ ﺧﻼلmicrovasclar وﯾﺘﻢ اﻟﺤﻔﺎظ ﻋﻠﻰ ﺳﺎﻟﻜﯿﺔ، اﻷﻧﺴﺠﺔ واﻟﻐﺪد
اﻟﺒﺮوﺳﺘﺎﺟﻼﻧﺪﯾﻦ اﻟﺬي ﯾﺴﺎﻋﺪ ﻓﻲ اﻹﺟﺮاءات اﻟﺘﺎﻟﯿﺔ
1- epithelial mucus secretions.
2- secretion of HCO3.
3- maintains mucosal blood flow.
4- maintains epithelial proliferation.
Peptic ulcers ية01ا`_ ا
are a common clinical problem characterized by mucosal defects of the
mucosa of the stomach or the duodenum. Men and women are at equal risk
for developing PUD, and the overall lifetime risk for both genders is 10%.
اﻟﺮﺟﺎل.ھﻲ ﻣﺸﻜﻠﺔ ﺳﺮﯾﺮﯾﺔ ﺷﺎﺋﻌﺔ ﺗﺘﻤﯿﺰ ﺑﻌﯿﻮب ﻣﺨﺎطﯿﺔ ﻓﻲ اﻟﻐﺸﺎء اﻟﻤﺨﺎطﻲ ﻟﻠﻤﻌﺪة أو اﻻﺛﻨﻲ ﻋﺸﺮ
.٪10 وﻣﺨﺎطﺮ اﻟﻌﻤﺮ اﻹﺟﻤﺎﻟﯿﺔ ﻟﻜﻼ اﻟﺠﻨﺴﯿﻦ ھﻲ، PUD واﻟﻨﺴﺎء ﻣﻌﺮﺿﻮن ﻟﺨﻄﺮ ﻣﺘﺴﺎ ٍو ﻟﺘﻄﻮﯾﺮ
The most important risk factors for the development of peptic ulcers are
infection with H. pylori and use of NSAIDs and stress.
إن أھﻢ ﻋﻮاﻣﻞ اﻟﺨﻄﺮ ﻟﺘﻄﻮر اﻟﻘﺮﺣﺔ اﻟﮭﻀﻤﯿﺔ ھﻲ اﻹﺻﺎﺑﺔ ﺑﺎﻟﺒﻜﺘﯿﺮﯾﺎ اﻟﺤﻠﺰوﻧﯿﺔ اﻟﺒﻮاﺑﯿﺔ واﺳﺘﺨﺪام
.ﻣﻀﺎدات اﻻﻟﺘﮭﺎب ﻏﯿﺮ اﻟﺴﺘﯿﺮوﺋﯿﺪﯾﺔ واﻟﺘﻮﺗﺮ
Common sites of gastric ulcer is in the antrum and the lesser curvature,
Common sites of the duodenal ulcer is in the first part (the bulb).
واﻟﻤﻮاﻗﻊ اﻟﺸﺎﺋﻌﺔ ﻟﻘﺮﺣﺔ اﻻﺛﻨﻲ، اﻟﻤﻮاﻗﻊ اﻟﺸﺎﺋﻌﺔ ﻟﻘﺮﺣﺔ اﻟﻤﻌﺪة ﻣﻮﺟﻮدة ﻓﻲ اﻟﻐﺎر واﻻﻧﺤﻨﺎء اﻷﻗﻞ
.(ﻋﺸﺮ ھﻲ ﻓﻲ اﻟﺠﺰء اﻷول )اﻟﺒﺼﯿﻠﺔ
The risk for NSAID induced ulceration and complications is dose related
and increases with age older than 60 years, concurrent corticosteroid use,
increasing duration and dose of therapy, anticoagulant therapy, and a
history of prior ulcer disease
ﯾﺮﺗﺒﻂ ﺧﻄﺮ ﺣﺪوث ﺗﻘﺮﺣﺎت وﻣﻀﺎﻋﻔﺎت ﻧﺎﺗﺠﺔ ﻋﻦ ﻣﻀﺎدات اﻻﻟﺘﮭﺎب ﻏﯿﺮ اﻟﺴﺘﯿﺮوﺋﯿﺪﯾﺔ ﺑﺎﻟﺠﺮﻋﺔ
وزﯾﺎدة ﻣﺪة، واﻻﺳﺘﺨﺪام اﻟﻤﺘﺰاﻣﻦ ﻟﻠﻜﻮرﺗﯿﻜﻮﺳﺘﯿﺮوﯾﺪ، ﻋﺎ ًﻣﺎ60 وﯾﺰﯾﺪ ﻣﻊ ﺗﻘﺪم اﻟﻌﻤﺮ أﻛﺜﺮ ﻣﻦ
وﺗﺎرﯾﺦ ﻣﺮض اﻟﻘﺮﺣﺔ اﻟﺴﺎﺑﻘﺔ، واﻟﻌﻼج ﺑﻤﻀﺎدات اﻟﺘﺨﺜﺮ، وﺟﺮﻋﺔ اﻟﻌﻼج
Symptoms اضRSا
Patient with peptic ulcer may be a symptomatic or presented with abdominal
pain, vomiting, or bleeding
ﻗﺪ ﯾﻜﻮن اﻟﻤﺮﯾﺾ اﻟﻤﺼﺎب ﺑﺎﻟﻘﺮﺣﺔ اﻟﮭﻀﻤﯿﺔ أﻋﺮاﺿﺎ أو ﯾﻌﺎﻧﻲ ﻣﻦ أﻟﻢ ﻓﻲ اﻟﺒﻄﻦ أو اﻟﻘﻲء أو
اﻟﻨﺰﯾﻒ
Diagnosis is with Endoscopy TاخV اWXY اZ [ال]خ
Treatment is with stop nsaid, treatment of H pylori, give Proton Pump
Inhibitors like omeprazole.
وﻋﻼج ﺟﺮﺛﻮﻣﺔ اﻟﻤﻌﺪة وإﻋﻄﺎء ﻣﺜﺒﻄﺎت ﻣﻀﺨﺔ اﻟﺒﺮوﺗﻮن ﻣﺜﻞnsaid ﯾﺘﻢ اﻟﻌﻼج ﺑﺈﯾﻘﺎف
.أوﻣﯿﺒﺮازول
Complications of Peptic Ulcer Disease ية01ض ا`_ اq اعفاتt
1-Bleeding:- PUD is the leading cause of upper GI bleeding, due to erosion
of the mucus epithelial surface reaching the blood vessels.
ﺑﺴﺒﺐ ﺗﺂﻛﻞ، ﯾﻌﺘﺒﺮ اﻟﻘﺮﺣﺔ اﻟﮭﻀﻤﯿﺔ ھﻮ اﻟﺴﺒﺐ اﻟﺮﺋﯿﺴﻲ ﻟﻨﺰﯾﻒ اﻟﺠﮭﺎز اﻟﮭﻀﻤﻲ اﻟﻌﻠﻮي- :اﻟﻨﺰﯾﻒ
.اﻟﺠﮭﺎز اﻟﮭﻀﻤﻲ اﻟﺴﻄﺢ اﻟﻈﮭﺎري اﻟﻤﺨﺎطﻲ اﻟﺬي ﯾﺼﻞ إﻟﻰ اﻷوﻋﯿﺔ اﻟﺪﻣﻮﯾﺔ
2-Perforation:- Perforation, which occurs when a peptic ulcer erodes
through the full thickness of the stomach or duodenum
اﻧﺜﻘﺎب ﯾﺤﺪث ﻋﻨﺪﻣﺎ ﺗﺘﺂﻛﻞ اﻟﻘﺮﺣﺔ اﻟﮭﻀﻤﯿﺔ ﻣﻦ ﺧﻼل اﻟﺴﻤﺎﻛﺔ اﻟﻜﺎﻣﻠﺔ ﻟﻠﻤﻌﺪة أو اﻻﺛﻨﻲ- :اﻻﻧﺜﻘﺎب
.ﻋﺸﺮ
3-Gastric Outlet Obstruction:- edema, spasm, and inflammation lead to
obstruction, or as a consequence of chronic ulceration with scarring and
fibrosis.
ﺗﺆدي اﻟﻮذﻣﺔ واﻟﺘﺸﻨﺞ واﻻﻟﺘﮭﺎب إﻟﻰ اﻧﺴﺪاد أو ﻧﺘﯿﺠﺔ ﺗﻘﺮح ﻣﺰﻣﻦ- :اﻧﺴﺪاد ﻣﺨﺮج اﻟﻤﻌﺪة
.ﻣﺼﺤﻮب ﺑﺘﻨﺪب وﺗﻠﯿﻒ
Helicobacter pylori are curved, flagellated, gram-negative rods found only
in gastric epithelium. However, only a minority of patients with H. pylori
gastritis develop peptic ulcer disease (PUD) or gastric cancer
وﻣﻊ.ھﯿﻠﯿﻜﻮﺑﺎﻛﺘﺮ ﺑﯿﻠﻮري ھﻲ ﻗﻀﺒﺎن ﻣﻨﺤﻨﯿﺔ وﻣﺠﻠﺪة وﺳﻠﺒﯿﺔ اﻟﺠﺮام ﺗﻮﺟﺪ ﻓﻘﻂ ﻓﻲ ظﮭﺎرة اﻟﻤﻌﺪة
ﻓﺈن أﻗﻠﯿﺔ ﻓﻘﻂ ﻣﻦ ﻣﺮﺿﻰ اﻟﺘﮭﺎب اﻟﻤﻌﺪة اﻟﺤﻠﺰوﻧﯿﺔ اﻟﺒﻮاﺑﯿﺔ ﯾﺼﺎﺑﻮن ﺑﻤﺮض اﻟﻘﺮﺣﺔ اﻟﮭﻀﻤﯿﺔ، ذﻟﻚ
أو ﺳﺮطﺎن اﻟﻤﻌﺪة
Factors important in the organism’s ability to colonize the stomach include its :
:T استعمار ا<عدة ما يh i اjk قدرة الm ل ا*وامل ا<همةp
1- Motility with flagella
2- production of urease which produce Ammonia that neutralizes acid.
3- bacterial adherence اﻟﺤﺮﻛﺔ ﻣﻊ اﻷﺳﻮاط-1
. إﻧﺘﺎج اﻟﯿﻮرﯾﺎز اﻟﺬي ﯾﻨﺘﺞ اﻷﻣﻮﻧﯿﺎ اﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ﺗﺤﯿﯿﺪ اﻟﺤﻤﺾ-2
اﻻﻟﺘﺼﺎق اﻟﺒﻜﺘﯿﺮي-3
NSAIDs
are one of the most widely used classes of drugs. It affects the mucosa
through decreased synthesis of mucosal prostaglandins
إﻧﮫ ﯾﺆﺛﺮ ﻋﻠﻰ اﻟﻐﺸﺎء اﻟﻤﺨﺎطﻲ ﻣﻦ ﺧﻼل اﻧﺨﻔﺎض.ھﻲ إﺣﺪى ﻓﺌﺎت اﻷدوﯾﺔ اﻷﻛﺜﺮ اﺳﺘﺨﺪا ًﻣﺎ
ﺗﺨﻠﯿﻖ اﻟﺒﺮوﺳﺘﺎﺟﻼﻧﺪﯾﻨﺎت اﻟﻤﺨﺎطﯿﺔ
NSAID-related mucosal injury
This includes sub-epithelial hemorrhages, erosions, and ulcerations,
erosions are likely to be small and superficial, whereas ulcers tend to be
larger (more than 5 mm in diameter) and deeper.
وﻣﻦ اﻟﻤﺮﺟﺢ أن ﺗﻜﻮن اﻟﺘﻘﺮﺣﺎت ﺻﻐﯿﺮة، وھﺬا ﯾﺸﻤﻞ اﻟﻨﺰﯾﻒ ﺗﺤﺖ اﻟﻈﮭﺎري واﻟﺘﺂﻛﻞ واﻟﺘﻘﺮﺣﺎت
. ﻣﻢ( وأﻋﻤﻖ5 ﻓﻲ ﺣﯿﻦ أن اﻟﻘﺮﺣﺎت ﺗﻤﯿﻞ إﻟﻰ أن ﺗﻜﻮن أﻛﺒﺮ )ﻗﻄﺮھﺎ أﻛﺜﺮ ﻣﻦ، وﺳﻄﺤﯿﺔ
Stress-Related Gastric Mucosal Damage
During critical illness, events such as shock, hypotension,
and catecholamine release are associated with reduced blood flow and
mucosal ischemia. When blood flow to the mucosa is inadequate, the
normal mucosal protective mechanisms, including epithelial turnover
and mucus and HCO3 secretion, are altered.
وإطﻼق اﻟﻜﺎﺗﯿﻜﻮﻻﻣﯿﻦ ﯾﺮﺗﺒﻂ، اﻧﺨﻔﺎض ﺿﻐﻂ اﻟﺪم، أﺣﺪاث ﻣﺜﻞ اﻟﺼﺪﻣﺔ، أﺛﻨﺎء اﻟﻤﺮض اﻟﺨﻄﯿﺮ
ﻋﻨﺪﻣﺎ ﯾﻜﻮن ﺗﺪﻓﻖ اﻟﺪم إﻟﻰ اﻟﻐﺸﺎء اﻟﻤﺨﺎطﻲ.ﺑﺎﻧﺨﻔﺎض ﺗﺪﻓﻖ اﻟﺪم وﻧﻘﺺ ﺗﺮوﯾﺔ اﻟﻐﺸﺎء اﻟﻤﺨﺎطﻲ
ﺑﻤﺎ ﻓﻲ ذﻟﻚ دوران اﻟﻈﮭﺎرة، ﯾﺘﻢ ﺗﻐﯿﯿﺮ آﻟﯿﺎت اﻟﺤﻤﺎﯾﺔ اﻟﻄﺒﯿﻌﯿﺔ ﻟﻠﻐﺸﺎء اﻟﻤﺨﺎطﻲ، ﻛﺎف
ٍ ﻏﯿﺮ
.HCO3 واﻟﻤﺨﺎط وإﻓﺮاز
