Peptic ulcer

Question 1

Gastric ulcer

Answer 1

Pain: greater with meals, weight loss
H pylori 75%
Cause: decreased mucosal protection from acid, NSAID also implicated
Risk of carcinoma: increased
Other:  in older adults

Question 2

Duodenal ulcer

Answer 2

Pain: less with meals, weight gain (vs. gastric)
H pylori 100%
Cause: decreased mucosal protection or increased gastric acid secretion (ZES)
Risk of carcinoma: generally benign
Other: hypertrophy of Brunner’s glands

Question 3

Ulcer complications:

hemorrhage

Answer 3

Gastric, duodenal (posterior>anterior)

Rupture of gastric ulcers on less curvature: bleeding from left gastric artery

Ulcer on posterior wall: bleeding from gastroduodenal artery

Question 4

Ulcer complication:

perforation

Answer 4

Duodenal (anterior>posterior)