<prompt> Peptic ulcer is associated with all except one ?CirrhosisZollinger Ellisons syndromePrimary hyperparathyroidismPernicious anemia  <response>: Ans is d ie Pernicious anemia You, dont expect pernicious anemia to cause peptic ulcer. In pernicious anemia there is autoimmune destruction of the parietal cells leading to hypochlorhydria which fuher progresses to achlorhydria. ---, Etiology of Peptic Ulcer Acute peptic Ulcer i NSAIDS Ingestion ii Stress - Cushing ulcer after cerebral trauma - Curling ulcer after burn injury, any kind of shock iii Sepsis -- Undrained pus may be responsible for acute ulcer. iv Steroids Chronic Gastric Ulcer i NSAIDs Ingestion - NSAIDs disrupt the prostaglandin driven suppo 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. ii Helicobacter pylori - H.Pylori is seen in almost 90 of cases of duodenal ulcer and 70 of cases of gastric ulcer. iii Pyloroduodenal reflux - Regurgitate bile other duodenal juices. iv Mucosal trauma - by mechanical effect of food. v Diet smoking - Irregular diet, spicy food excessive drinking of tea coffee, alcohol, Cigarette smoking has a definite relation with both gastric duodenal ulcers. vi Emotional factors - Anxiety, Stress strain. vii Liver disease - Ulceration of both stomach and duodenum have co-existed with disease of the liver paicularly 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 Ulcer i Acid hypersecretion ii Genetic factors - Persons of blood group 0 who do not possess AB antigen are peculiarly apt to develop duodenal ulcer. iii Endocrinal disorders - Zollinger Ellison syndrome Hyperparathyroidism - Multiple adenoma syndrome MEN-I - Cushing syndrome bc of high level of endogenous steroids iv Chronic liver diseases v Chronic lung disease vi Chronic pancreatitis vii Emotional factor viii Diet smoking ix H.pylori x Decrease in bicarbonate production The list may be exhaustive but questions have been repeatedly asked on etiology of peptic ulcers. 