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.