Peptic ulcer disease: Difference between revisions
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==Complications== | ==Complications== | ||
*Hemorrhage | |||
**[[Upper GI Bleeding]] | |||
*Perforation | |||
**Most commonly occurs in anterior wall of duodenum. | |||
**Abrupt onset of severe epigastric pain | |||
**Pts may not have history of ulcer-like sx | |||
**Consult surgery | |||
*Obstruction | |||
**Occurs due to: | |||
***Scarring of gastric outlet | |||
***Edema due to active ulcer | |||
==See Also== | ==See Also== | ||
Revision as of 06:22, 18 February 2015
Background
- Recurrent ulcerations in the stomach and proximal duodenum
- Majority of cases related to H. pylori or NSAID use
- H. pylori found in 30-40% of U.S. population
- NSAIDs inhibit prostaglandin synthesis (decreases mucus and bicarb production)
Diagnosis
- Burning epigastric pain
- May awaken pt at night (gastric contents empty)
- Abrupt onset of severe pain may indicate perforation
- Abrupt onset of back pain may indicate penetration into the pancreas
- The following symptoms are NOT associated w/ PUD:
- Postprandial pain, food intolerance, nausea, retrosternal pain, belching
Work-Up
- CBC (r/o anemia)
- LFTs
- Lipase
- ?Acute abd series
- ?RUQ US
- ?ECG
- ?Troponin
Differential Diagnosis
Epigastric Pain
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- SMA syndrome
- Pulmonary embolism
- Bezoar
- Ingested foreign body
Treatment
- Eradicate H. pylori if identified in symptomatic pt
- PPI + clarithromycin + (amoxicillin or metronidazole) x14d
- Stop NSAIDs
- PPI
- Generally heal ulcers faster than H2 blockers
- Omeprazole 20-40mg QD
- H2 Blockers
- Famotidine 20-40mg QD
- Ranitidine 75-150mg BID
Disposition
- Normally outpatient management, unless complication (see below)
Red Flags
Any of the following suggest need for endoscopy referral:
- Age >55yr
- Unexplained weight loss
- Early satiety
- Persistent vomiting
- Dysphagia
- Anemia or GI bleeding
- Abdominal mass
- Persistent anorexia
- Jaundice
Complications
- Hemorrhage
- Perforation
- Most commonly occurs in anterior wall of duodenum.
- Abrupt onset of severe epigastric pain
- Pts may not have history of ulcer-like sx
- Consult surgery
- Obstruction
- Occurs due to:
- Scarring of gastric outlet
- Edema due to active ulcer
- Occurs due to:
See Also
Source
Tintinalli