Ulcers:

Etiology: Associated with normal acidity or hyposecretion.

Atrophic gastritis.

Constant association with smoking.

Pathology: Chronic gastric ulcer is larger than a duodenal ulcer.

Floor is situated in muscular coats and as time goes ulcer occupying posterior wall becomes adherent to and later erodes the pancreas.

Chronic ulcer in anterosuperior aspect of stomach can penetrate the liver.

Saddle shaped ulcer situated on lesser curve can penetrate both liver and pancreas.

Do peptic ulcer become malignant?

- Chronic duodenal ulcer never become carci nomatous.

- Chronic gastric ulcer may become malignant.

Frequency : See Fig 1

GI hemorrhage

May be first sign of PUD, often may be occult. Bleeding often first sign in patients taking NSAIDs.

Perforation

More common in ulcers in the anterior wall of the abdomen. Patient will have absent bowel sounds, rebound tenderness and rigid abdomen. Upright or R lateral decubitus films will show intraperitoneal air.

Gastric carcinoma

Requires high index of suspicion. Suspect also in patients presenting with gastric outlet obstruction.

Endoscopy with biopsy diagnostic.

Clinical features of Gastric & Duodenal Ulcers

Gastric Duodenal

Periodicity Present Well marked.

Pain Soon after eating 2 hours after eating.

Vomiting Considerable No vomiting.

Hemorrhage Haemetemesis more Melena more frequent than haemetemesis.

Appetite Afraid to eat Good.

Diet Lives on milk and fish Takes almost anything.

Weight Loss of weight No loss of weight.

Special investigations:

1. Fibreoptic esophagogastroduodenoscopy: useful in diagnosis of gastric ulcer, results of medical treatment, carcinoma, examination of stoma in suspected stomal ulceration and also in diagnosis of chronic duodenal ulcer.

2. Barium meal studies : Ulcer Niche-gastric and antral ulcers.

Ulcers crater filled with barium - Duodenal ulcers.

Pyloric stenosis and hour glass contracture - characteristic appearances.

3. Tests for gastric secretion:

a) Pentagastrin test.

b) Hollanders insulin test.

c) Chew and spit test.

Comment & Contribute Comments should be on the topic and should not be abusive. Comments are normally moderated and are reviewed after they are posted. Post your comments * Your comment can be maximum of 2500 characters I agree to the terms and conditions Your comments are automatically posted once they are submitted. All comments are however constantly reviewed for spam and irrelevant material (such as product or personal advertisements, email addresses, telephone numbers and website address). Such insertions do not conform to our policy and 'Terms of Use' and are either deleted or edited and republished. Please keep your comments brief and relevant.This section may also have questions seeking help. If you have the information you are welcome to respond, but please ensure that the information so provided is genuine and not misleading. If you have a question about health related issues, you can now post it in our Ask An Expert section on our community website Medwonders.com and get answers from our panel of experts. Member Comments ( 11 ) useful information (Posted by sivakumar99, India Date : 9/5/2011 ) i am suffering a stomach ache and the doctor told me that i have acid peptic deasease. what kind of food should i take? thank you so much nikki from philippines (Posted by nikkay_28, Philippines Date : 3/28/2011 ) i want to feel 1.5 years suffer burning in my stomuch but it is not right. i check endoscopy. answare is amtal gastritis/duodenal erosions. also biopsy that report is "Mild chronic antral gastritis, negative for H-pylori, gastric antral(endoscopic)biopsy." it is hapend 6 month ago. medicin doctor has been given nekfiune,zentel, nultivite gold. for 2 month but it is not work properly (Posted by LaltuSarkar, N/A Date : 3/22/2011 ) hi i've just been diagnosed with acid peptic disease and i was wondering what we can and cannot eat (Posted by jforkner_013, United States Date : 12/2/2010 ) Good Day,iam Roly currently working in dubai. Last 2 days i was suffering from a severe stomach & chest pain, i'm running out of breath and was directly rush to hospital. I was diagnose of having an Acid Peptic Disease, the doctor gave me 2 types of Antibiotics, hyoscine, & omeprazole 20mg. Lots of food restrictions was given to me and i'm totally confused of what kind/types of foods should i take. Please give me some tips on how to properly treat this kind of Disease & what are the foods should i take? (Posted by Roly75, United Arab Emirates Date : 11/26/2010 ) View All Comments (11)