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Peptic Ulcer

 Syn. Gastroduodenal Ulcer , PUD , Peptic Ulcer Disease

Signs & Symptoms

 Awakes the patient from sleep #DU
Ref: Harrison [ 2227]
Relief with anti secretory agents
Ref: Uptodate [ Clinical manifestations of peptic ulcer disease]
Centered in epigastrium
Ref: Uptodate [ Clinical manifestations of peptic ulcer disease]
Epigastric pain #Ulcer-like_dyspepsia #acid_dyspepsia
Ref: Uptodate [ Clinical manifestations of peptic ulcer disease] Harrison [ 74] Cecil [ 24]

Physical Examination

 Patient show site of pain with one finger
Ref: Epocrates [ https://online.epocrates.com/diseases/8031/Peptic-ulcer-disease/Diagnostic-Approach]
Epigastric tenderness
Ref: Epocrates [ https://online.epocrates.com/diseases/8031/Peptic-ulcer-disease/Diagnostic-Approach]
Heard succussion splash
Note: in patients with pyloric stenosis (caused by gastric outlet obstruction)
Ref: Epocrates [ https://online.epocrates.com/diseases/8031/Peptic-ulcer-disease/Diagnostic-Approach]

Lab / Serology

 Helicobacter pylori infection
Ref: Harrison [ 607]
Elevated carcinoembryonic antigen
Ref: Uptodate [ Clinical manifestations, diagnosis, and staging of colorectal cancer]
Iron deficiency anemia
Note: may be sudden, with the signs of bleeding (hematemesis and/or melena and shock), or perforation with peritonitis
Ref: Epocrates [ https://online.epocrates.com/diseases/8031/Peptic-ulcer-disease/Diagnostic-Approach]

Imagin Study

Complication

 Pain radiate to back #duodenal_ulcers
Note: due to penetration of the ulcer posteriorly into the pancreas
Ref: Epocrates [ https://online.epocrates.com/diseases/8031/Peptic-ulcer-disease/Diagnostic-Approach]
Upper GI bleeding
Note: Bleeding and complications of ulcer disease occur more often in individuals >60 years of age
Ref: Harrison [ 2227]
Gastric outlet obstruction
Ref: Harrison [ 2227]

Risk Factors

 Cigarette smoking
Ref: Epocrates [ https://online.epocrates.com/diseases/8032/Peptic-ulcer-disease/Risk-Factors]
Elder
Ref: Epocrates [ https://online.epocrates.com/diseases/8032/Peptic-ulcer-disease/Risk-Factors]
Family history of peptic ulcer disease
Ref: Epocrates [ https://online.epocrates.com/diseases/8032/Peptic-ulcer-disease/Risk-Factors]

Cause

 Caused by annular pancreas
Ref: Harrison [ 2449]

Other