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Clinical VignetteA clinical vignette is a concise presentation of an interesting or challenging patient encounter that stimulated an interesting learning issue.
A 39 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
I Love Clinical Vignette a concise presentation of an interesting & challenging patient encounter that stimulates an inquisitive learning session.
The Following User Says Thank You to Oak For This Useful Post:
A 39 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
E.pepsin production
well iam busy these days so i miss this forum and you as well as hero see u later bro after my exams.
The Following User Says Thank You to bharat For This Useful Post:
Re: Female develops gastric stress ulcer after RTA -
06-09-2006, 09:01 AM
Stress ulceration, a disease associated with the stress of severe injury, sepsis, and organ failure, has declined in frequency during the last decade. Factors contributing to this decrease include more rapid transport of trauma patients, early resuscitation, avoidance and treatment of complications, and prophylactic maintenance of increased gastric mucosal pH. The pathophysiology of these lesions remains to be elucidated completely; however, both aggressive factors (acid, duodenal reflux, etc.) and a deficiency in defensive mechanisms (gastric mucosal blood flow, gastric mucosal barrier, mucus, bicarbonate, etc.) play a role in their inception. The hemorrhagic complication of stress ulcer, which is usually seen between the fifth and tenth days after admission, remains a sequela associated with a significant rate of mortality.
The Following User Says Thank You to flirt For This Useful Post:
Yh, 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 all the best for your exams
I Love Clinical Vignette a concise presentation of an interesting & challenging patient encounter that stimulates an inquisitive learning session.
The Following User Says Thank You to Oak For This Useful Post:
Re: Female develops gastric stress ulcer after RTA -
12-09-2006, 07:44 AM
Quote:
Originally Posted by bharat
well iam busy these days so i miss this forum and you as well as hero see u later bro after my exams.
kasto hudaicha exam? all the best.
hamro ta new semester start bhayo, timro aile exam hudaicha? --weifang ho hero timi nai hou bhanne suneko thiye
though u don;t know me, tara weifang ko detail chha ma sanga hahaha.. anyways good luck!!!
The Following User Says Thank You to Hero For This Useful Post:
--weifang ho hero timi nai hou bhanne suneko thiye 
anyways good luck!!!
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