Acute gastric stress ulcer in a hospitalized female after motor vehicle accident

[Oak]

A 34 year old female, hospitalized after a motor vehicle accident, develops acute gastric stress ulcers. Increases in which of the following normal physiological parameters may have contributed to this condition?

A. Bicarbonate transport
B. Epithelial regenerative capacity
C. Mucosal blood flow
D. Mucus secretion
E. Pepsin production

[bharat]

Originally Posted by Oak

A 34 year old female, hospitalized after a motor vehicle accident, develops acute gastric stress ulcers. Increases in which of the following normal physiological parameters may have contributed to this condition?

A. Bicarbonate transport
B. Epithelial regenerative capacity
C. Mucosal blood flow
D. Mucus secretion
E. Pepsin production

well regarding this condition i will go for option C. mucosal blood flow (ischemia)
well here is my explanation
Stress ulcers are superficial mucosal lesions located predominantly in the fundus of the stomach. They occur mainly in the victims of severe trauma and sepsis and are to be clearly distinguished from Cushing's ulcers, ulcers induced by drugs and from activation of a preexistent ulcer. It is generally agreed that mucosal ischemia is the major inciting event in the pathogenesis of acute stress ulceration of the stomach and that the presence of luminal acid and pepsin are required for overt ulceration to develop. Back-diffusion of acid occurs in the absence of overt disruption of the gastric mucosal barrier, is closely related to the formation of ulcers, and may be enhanced by reflux of duodenal content into the stomach and by diffusion of blood urea into the stomach. Severe acidosis and base deficit together with depression of acid secretion and consequent lowering of alkaline tide are important contributing factors. A differential energy deficit in fundic mucosa as a result of ischemia probably contributes to mucosa damage by interfering with anion exchange (HCO 3 – for Cl–). The exact role of steroids and prostaglandins is controversial.
well if iam incorrect please correct me ok

[Oak]

The correct answer is E. Pepsin production is a normal physiologic activity of the stomach that, in conditions of stress, may overwhelm the stomach's weakened defenses and result in gastric ulceration. Gastric acid production is another condition that may increase and cause acute ulceration.

Furthermore, these two factors may remain unchanged and still result in gastric ulcers if the gastric defenses are weakened by stress. All of the other choices represent normal defensive forces in the stomach.

Increased bicarbonate transport (choice A) would protect the gastric epithelium from the potentially harmful acidity of the gastric contents. The adherent mucus is relatively alkaline, providing local protection to the superficial mucosa.

Gastric epithelial cells can normally replicate rapidly, allowing mucosal defects to be rapidly repaired. Increasing the regenerative capacity of the epithelium (choice B) would have a protective effect against ulceration.

The gastric mucosa is richly supplied with blood, providing the epithelial cells with an ample supply of nutrients, oxygen, and bicarbonate to contend with the harsh gastric microenvironment. Stress ulcers are associated with compromised gastric blood flow, not increased flow (choice C).

Mucus protects the gastric epithelium by virtue of being water insoluble, impermeable to pepsin, and slowly permeated by acid (H+). Increasing mucus production (choice D) has a protective effect for the gastric mucosa.


bharat you are absolutely correct but you didn't read the last part of the question it was "Increases in which of the following normal physiological parameters may have contributed to this condition?"

That means mean you had to add "Increases in" in all the question so the options becomes

A. Increases in Bicarbonate transport
B. Increases in Epithelial regenerative capacity
C. Increases in Mucosal blood flow
D. Increases in Mucus secretion
E. Increases in Pepsin production

Hope I am clear now.

[bharat]

Originally Posted by Oak

The correct answer is E. Pepsin production is a normal physiologic activity of the stomach that, in conditions of stress, may overwhelm the stomach's weakened defenses and result in gastric ulceration. Gastric acid production is another condition that may increase and cause acute ulceration.

Furthermore, these two factors may remain unchanged and still result in gastric ulcers if the gastric defenses are weakened by stress. All of the other choices represent normal defensive forces in the stomach.

Increased bicarbonate transport (choice A) would protect the gastric epithelium from the potentially harmful acidity of the gastric contents. The adherent mucus is relatively alkaline, providing local protection to the superficial mucosa.

Gastric epithelial cells can normally replicate rapidly, allowing mucosal defects to be rapidly repaired. Increasing the regenerative capacity of the epithelium (choice B) would have a protective effect against ulceration.

The gastric mucosa is richly supplied with blood, providing the epithelial cells with an ample supply of nutrients, oxygen, and bicarbonate to contend with the harsh gastric microenvironment. Stress ulcers are associated with compromised gastric blood flow, not increased flow (choice C).

Mucus protects the gastric epithelium by virtue of being water insoluble, impermeable to pepsin, and slowly permeated by acid (H+). Increasing mucus production (choice D) has a protective effect for the gastric mucosa.


bharat you are absolutely correct but you didn't read the last part of the question it was "Increases in which of the following normal physiological parameters may have contributed to this condition?"

That means mean you had to add "Increases in" in all the question so the options becomes

A. Increases in Bicarbonate transport
B. Increases in Epithelial regenerative capacity
C. Increases in Mucosal blood flow
D. Increases in Mucus secretion
E. Increases in Pepsin production

Hope I am clear now.

sorry i didnot saw that thing well i suppose that was my blunder mistake well hope from next timeon i will read the question two times . well i earlier thought the option were some what incomplete coz. there was no increase and decrese but now i know where i was wrong at? thanks bro you should do this for me hope i already got it. i will keep it in mind hahha