A Cushing ulcer, named after

Harvey Cushing Harvey Williams Cushing (April 8, 1869 – October 7, 1939) was an American neurosurgeon, pathologist, writer, and draftsman. A pioneer of brain surgery, he was the first exclusive neurosurgeon and the first person to describe Cushing's disease. ...

, is a

gastric ulcer Peptic ulcer disease (PUD) is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines i ...

associated with elevated

intracranial pressure Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury (mmHg) and at rest, is normally 7–15 Millimeter of mercury, mmHg ...

. It is also called von Rokitansky–Cushing syndrome. Apart from the stomach, ulcers may also develop in the proximal

duodenum The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear, and the terms anterior intestine or proximal intestine m ...

and distal

esophagus The esophagus (American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the ...

Causes

The mechanism of development of Cushing ulcers is thought to be due to direct stimulation of vagal nuclei as a result of increased

. Brain tumors, traumatic head injury, and other intracranial processes including infections, can cause increased intracranial pressure and lead to overstimulation of the vagus nerve.

Efferent Efferent may refer to: Anatomical structures Meaning 'conveying away from a center': *Efferent arterioles, conveying blood away from the Bowman's capsule in the kidney *Efferent nerve fiber, carries nerve impulses away from the central nervous sy ...

fibers of the

vagus nerve The vagus nerve, also known as the tenth cranial nerve, cranial nerve X, or simply CN X, is a cranial nerve that interfaces with the parasympathetic control of the heart, lungs, and digestive tract. It comprises two nerves—the left and right ...

then release

acetylcholine Acetylcholine (ACh) is an organic chemical that functions in the brain and body of many types of animals (including humans) as a neurotransmitter. Its name is derived from its chemical structure: it is an ester of acetic acid and choline. Part ...

onto gastric parietal cell M₃ receptors, causing insertion of hydrogen potassium ATPase vesicles into the apical plasma membrane. The end result is increased secretion of

gastric acid Gastric acid, gastric juice, or stomach acid is a digestive fluid formed within the stomach lining. With a pH between 1 and 3, gastric acid plays a key role in digestion of proteins by activating digestive enzymes, which together break down the ...

with eventual ulceration of the gastric mucosa.

Diagnosis

As Cushing ulcers have a higher incidence of developing after shock,

sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...

or trauma, diagnosis should include recent medical history evaluation. Both

endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

and angiography can be used to locate the

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classifi ...

or ulcer, though endoscopy is more commonly used as a first-line diagnosis procedure.

Treatment

Most episodes of Cushing ulceration resolve on medical intervention, consisting primarily of rinsing the area with

saline Saline may refer to: * Saline (medicine), a liquid with salt content to match the human body * Saline water, non-medicinal salt water * Saline, a historical term (especially US) for a salt works or saltern Places * Saline, Calvados, a commune in ...

and the administration of antacids. Patients should also be put on proton pump inhibitors during the course of treatment until their

lowers to a normal level. As it is caused due to vagal stimulation, vagotomy is considered as last treatment resort. .

References

External links

Duodenum disorders {{disease-stub

Causes

Diagnosis

Treatment

See also

References

External links