Peptic Ulcer

Question 1

Classification

Answer 1

– Type I: Ulcer along the lesser curve of
stomach
– Type II: Two ulcers present - one gastric, one
duodenal
– Type III: repyloric ulcer
– Type IV: roximal gastroesophageal ulcer
– Type V: Anywhere

Question 2

Complication

Answer 2

Bleeding
Gastric outlet obstruction
Perforation
Penetration

Question 3

Clinical manifestation

Answer 3

Nausea
– Vomiting- due to partial or complete gastric
outlet obstruction
– Dyspepsia: bloating, distention, and fatty folde
intolerance
– Heartburn
– Anorexia, weight loss
– waterbrash (rush of saliva after an episode of
regurgitation to dilute the acid in esophagus)
– Hematemesis

Question 4

Physical exam

Answer 4

– pain at palpation over epigastrium/umbilical
– Succussion splash- gastric outlet obtsruction
– possible epigastric tenderness

Question 5

Diagnosis o h pylori

Answer 5

– Urea breath test
– Biopsy: detection of urease activity (using 
   rapid urease test) 
– Measurement of blood antibodies 
– Stool antigen test;

Question 6

Etiology

Answer 6

• Helicobacter pylori
  – NSAID
  – hypersecretory states: Zollinger-Ellison sdr.,
  G-cell hyperplasia, leukemias.

Question 7

Clinical manifestations:

– Epigastric pain (the most common symptom)

Answer 7

• Gnawing or burning character
• Occurs usually 2-3 hours after meals
• Relieved by food or antacids
• Occurs especially at night.
• May radiate to the back – possible complication !
• Penetration

Gastric ulcer: during or after meal
Duodenal ulcer: before meal