<prompt> A peptic ulcer is associated with all except one -CirrhosisZollinger Ellisons syndromePrimary hyperparathyroidismPernicious anemia  <response>: You, dont expect pernicious anemia to cause peptic ulcer. In pernicious anemia, there is autoimmune destruction of the parietal cells leading to hypochlorhydria which further progresses to achlorhydriaEtiology. of peptic ulcerAcute Peptic UlcerNSAIDS IngestionStressCushing ulcer after cerebral traumaCurling ulcer after burn injury, any kind of shockSepsis Undrained pus may be responsible for an acute ulcer.Steroids Chronic Gastric UlcerNSAIDs IngestionNSAIDs disrupt the prostaglandin driven support of the mucosal barrier.Prostaglandins are responsible for the prodn. of mucosal gel layer in the stomach, which provide a protective barrier to the gastric and duodenal lining.So disruption of this mucosal barrier allows even minimum amount of acid to cause ulceration.Helicobacter pyloriH.Pylori is seen in almost 90 of cases of duodenal ulcer and 70 of cases of gastric ulcer.Pyloroduodenal refluxRegurgitate bile other duodenal juices.Mucosal traumaby mechanical effect of food.Diet smokingIrregular diet, spicy food excessive drinking of tea coffee, alcohol, Cigarette smoking has a definite relation with both gastric duodenal ulcers.Emotional factorsAnxiety, Stress strain.Liver diseaseUlceration of both stomach and duodenum have co-existed with the disease of the liver, particularly cirrhosis.It may be due to increase in blood supply to the gastric mucosa and overproduction of histamine in the stomach wall to stimulate the parietal cell.Chronic Duodenal UlcerAcid hypersecretionGenetic factorsPersons of blood group O who do not possess AB antigen are peculiarly apt to develop a duodenal ulcer.iii.Endocrinal disordersZollinger Ellison syndromeHyperparathyroidismMultiple adenoma syndromes MEN-ICushing. syndrome bc of the high level of endogenous steroidsChronic liver diseasesChronic lung diseaseChronic pancreatitisEmotional factorDiet smokingH.pyloriThe decrease in bicarbonate productionThe list may be exhaustive but questions have been repeatedly asked on etiology of peptic ulcers. 