hi welcome to our video on
peptic ulcer disease now i want to make
sure you're
very focused because this next question
is incredibly complex
so i'm going to need you to pay intense
attention okay
so are you ready for this i'm going to
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
you're up
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 and
frankly i'd be kind of 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 want to explain to
you what happens
you've ever been like late for something
and you make a cake or a 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 linings 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
okay 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 okay so you've got that
coating
now part of what keeps that mucus really
effective
it's kind of that thick gel mucousy 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 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 into the
rest of the video
peptic ulcer disease means that you have
a like a small
erosion on your stomach it's an open
source that develop on the stomach
lining because
that stomach lining somehow gets exposed
to that gastric acid
so it can happen either in 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 until we call that a
perforation once you have that
perforation
now you're risking gi bleeding i mean
there's going to be lots of blood
leaving from that wound
emptying into your gut cavity and now
we've got a really big problem with your
patient
jab leads can be severe and lead to
shock and even
bigger problems so we want to 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
you hopefully you can remember they have
in a couple places it can be in the
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
they kind of
dip 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 all
right so you know those
by their trade names like tums or
something like that
we use those as antacids that will
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
choices when it comes to medications
that will make less gastric acid
available in our bodies
they're called h2 antagonists or proton
pump inhibitors okay so we can either
neutralize the acid we have
or make less acid available there's some
couple ways we can do it
we can also put like a liquid bandage or
a little band-aid on that boo-boo
on that sore that you have in your
stomach lining they use some medications
that like to caliphate
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 kind of have in mind
what are we treating
we're treating these wounds these sores
in the stomach
we want to deal with that gastric acid
because that's what started the wound or
that sore
in peptic ulcer disease and so we want
to help it heal
we've got to protect it from more of the
gastric acid we want to 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 going to lay
out those things that you want to keep
in mind when we're thinking about peptic
ulcers
disease so mucus 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 talked 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 work
together
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 suppressed
there's some of the medications that
suppress suppress
prostaglandins like nsaids
non-steroidal anti-inflammatories
so the most important point here i'd
like you to number those one
two three and four because i want you to
get your brain to recognize that
all four of these things need to be
healthy i almost
in healthy amounts because i want you to
almost think of it as a scale
if i have if i'm under attack and 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 than the
ability i have to defend my stomach
lining
then i'm going to end up with peptic
ulcer disease
[Music]
you