PEPTIC ULCER DISEASE.

Dr. Zachary Lahlou

Ulceration in the duodenal or gastric mucosa occurring when normal defense factors are impaired allowing erosion into the mucosal lining.

ETIOLOGY/ PATHOGENESIS

  • Gastric
  • Duodenal: more common
  • Occurs as a break in the gastric or duodenal mucosa when normal defensive factors are impaired or overwhelmed by acid and pepsin
  • More common in smokers
  • Causes: Chronic H. pylori (most common), NSAIDS, acid hypersecretion, Severe physiologic stress
  • Complications include hemorrhage and perforations
  • Stomach Malignancy associated with H Pylori, no increased risk of cancer
  • Associated with ulcers of other causes.

PERTINENT HISTORICAL FINDINGS/ CLINICAL SYMPTOMS

  • Dull gnawing pain
  • Periodic pain radiating to back or left upper quadrant
  • NSIADS ulcers are often painless
  • Pain may be exacerbated or relieved by food
  • Nausea, vomiting, hematemesis, and melana
  • Duodenal: Pain improves with food, pain occurs hours after meals and at night
  • Gastric: pain worsens shortly after meals = associated weight loss

PERTINENT PHYSICAL EXAM FINDINGS

  • Usually unrevealing

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