Commonest site involved in curling ulcer in a burn patient.
a. Curling ulcer is an acute peptic ulcer of the duodenum resulting as a complication from severe burn which reduces plasma volume leading to sloughing of the gastric mucosa.
b. Cushing ulcer is peptic ulceration associated with head injury due to increased ICP.
i. The gastrointestinal response to a burn is highlighted by mucosal atrophy, changes in digestive absorption, and increased intestinal permeability.
ii. Atrophy of the small bowel mucosa occurs within 12 hours of injury in proportion to the burn size and is related to increased epithelial cell death by apoptosis. .
iii. The cytoskeleton of the mucosal brush border undergoes atrophic changes associated with vesiculation of microvilli and disruption of the terminal web actin filaments.
iv. These findings were most pronounced 18 hours after injury, which suggests that changes in the cytoskeleton, such as those associated with cell death by apoptosis, are processes involved in the changed gut mucosa.
v. Burn also causes reduced uptake of glucose and amino acids, decreased absorption of fatty acids, and a reduction in brush border lipase activity.
These changes peak in the first several hours after a burn and return to normal at 48 to 72 hours after injury, a timing that parallels mucosal atrophy.
a. .Intestinal permeability to macromolecules, which are normally repelled by an intact mucosal barrier, increases after a burn.
b. Intestinal permeability to polyethylene glycol 3350, lactulose, and mannitol increases after injury in proportion to the extent of the burn.
c. Gut permeability increases even further when burn wounds become infected.