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Penetrating Duodenal or Gastric Ulcer


Presentation

  • Treatment and prognosis Treatment depends on the clinical presentation.[radiopaedia.org]
  • That is why the clinical presentation of posterior gastric perforation is less dramatic than that of the more common anterior perforations and is characterized by late presentation.[ejs.eg.net]
  • Abstract The present study was undertaken in an attempt to estimate the frequency with which the clinician is faced with the problem of a gastric lesion of questionable diagnosis.[annals.org]
  • We report a case of a young patient who presented both of these diseases, the first being the suspected cause of the second, with portal vein thrombosis and portal cavernoma. All these pathologies simultaneously present are even more unusual.[pancreas.imedpub.com]
Weight Loss
  • Maldigestion and steatorrhea caused by pancreaticobiliary bypass, especially with Billroth II anastomosis, may contribute to weight loss.[merckmanuals.com]
  • Other symptoms include nausea, vomiting, loss of appetite, weight loss and variation with eating (getting better or worse). When severe, peptic ulcer disease can lead to complications.[kzngastro.co.za]
  • Patients can present non-specific symptoms such as epigastric pain, vomiting, fever, weight loss, anorexia, upper GI bleeding among others, so a high index of suspicion is required (5,10) .[scielo.org.pe]
  • This leads to weight loss, vomiting, and even death in severe cases. What causes peptic ulcer disease? Despite a common misconception, ulcers are not caused by spicy foods or stress. Instead, most ulcers are caused by a bacterial infection.[gothammedicine.com]
  • Other symptoms may include: Bloated feeling Burping Lack of appetite or weight loss Nausea Bloody or dark poop Vomiting Small ulcers may not cause any symptoms. But if you notice any of these signs, talk to your doctor.[webmd.com]
Fever
  • Patients can present non-specific symptoms such as epigastric pain, vomiting, fever, weight loss, anorexia, upper GI bleeding among others, so a high index of suspicion is required (5,10) .[scielo.org.pe]
  • Symptoms will then reappear with blood like rigidity of the abdominal wall associated with fever and signs of shock and general collapse. An acute perforation is a possible surgical emergency and needs quick medical or surgical attention.[medicalonline.com.au]
  • Case Report A 63 years old male presented to our emergency department with history of epigastric pain and fever of 3 weeks duration.[tropicalgastro.com]
  • The signs of an ulcer perforation are severe pain, fever, and tenderness when the doctor touches the abdomen. Most cases of perforation require emergency surgery. The mortality rate is about 5%. PENETRATION.[medical-dictionary.thefreedictionary.com]
  • May include sudden onset of the severe pain and fever, and a chemical peritonitis followed by bacterial peritonitis. Penetration.[newworldencyclopedia.org]
Abdominal Pain
  • Plain radiograph Abdominal films have little role in the setting of vague/chronic upper abdominal pain, and have a very low yield.[radiopaedia.org]
  • Can my upper abdominal pain be caused by other possibilities? Not all upper abdominal pain is due to peptic ulcer, gastritis or duodenitis. Your doctor can help you evaluate. Prevention Avoidance of prolonged NSAIDs is important.[singhealth.com.sg]
  • pain worse with eating.[medbullets.com]
  • About 15 percent to 20 percent of abdominal pains in children is due to peptic ulcer. Most primary peptic ulcer disease in children are seen in the ages between 8 and 17.[asianjournal.com]
  • A perforated ulcer can be dangerous as the initial symptoms of intense abdominal pain, nausea and vomiting may suddenly subside for several hours. This can lead to a false sense of relief.[medicalonline.com.au]
Severe Abdominal Pain
  • abdominal pain worse with eating.[medbullets.com]
  • Clinical features The patient presents with sudden onset of severe abdominal pain. The onset of pain is so sudden that the patient can often accurately pin-point the exact moment when the perforation occurred.[surgwiki.com]
Acute Abdomen
  • The patient presents with an acute abdomen. There is sudden, intense, continuous epigastric pain that spreads rapidly throughout the abdomen, often becoming prominent in the right lower quadrant and at times referred to one or both shoulders.[merckmanuals.com]
Pancreatic Pain
  • Posterior wall perforation leads to pancreatitis ; pain in this situation often radiates to back. Penetration is when the ulcer continues into adjacent organs such as liver and pancreas [3].[psychology.wikia.com]
Back Pain
  • Critical Essential Core Tested Community Questions (5) Sorry, this question is for PEAK Premium Subscribers only Sorry, this question is for PEAK Premium Subscribers only (M1.GI.4) A 41-year-old male who takes NSAIDs regularly for his chronic back pain[medbullets.com]
  • The doctor is more likely to suspect an ulcer if the patient has one or more of the following risk factors: male sex age over 45 recent weight loss, bleeding, recurrent vomiting, jaundice, back pain, or anemia history of using aspirin or other NSAIDs[medical-dictionary.thefreedictionary.com]
Uremia
  • Causes Stress Burns Curling ulcer Cerebral disease Cushing ulcer Uremia Steroid therapy Hyperparathyroidism (25% have ulcer disease) General Considerations Multiple in 2-8% Coexistent duodenal ulcer disease in 5-42% Duodenal to gastric ratio is 3:1 Multiple[learningradiology.com]
Stroke
  • This edition includes new guidelines for advanced cardiac life support (ACLS) and new information on disaster medicine and terrorism preparedness, thrombolytic therapy for stroke and heart attack, and alternative therapies.[books.google.com]
  • General Avoidance of alcohol and tobacco products; avoidance of pepper, coffee (caffeinated and decaffeinated), and foods that cause epigastric distress; avoidance of NSAIDs. acute myeloid leukemia peripheral smear diagnostic tests for hypertensive stroke[medi-info.com]
  • Aspirin used for heart and stroke patients is also in this group. Doctors often prescribe an antiulcer drug when prescribing these medications. With the exception of aspirin, NSAIDs should not be taken continuously.[singhealth.com.sg]
  • Engl J Med 2019; 380:347-357 In a randomized trial of patients with type 2 diabetes, treatment with dapagliflozin, an SGLT2 inhibitor that promotes glucosuria, did not result in a higher or lower rate of cardiovascular death, myocardial infarction, or stroke[nejm.org]
Agitation
  • Tachycardia, sweaty palms, hypotension, anxiety and agitation are signs of shock and call for urgent blood volume replacement.[surgwiki.com]

Treatment

  • Accepted abstracts had to include at least 2 treatment arms, to specify the diagnosis of patients, the exact drug doses, the duration of treatment and method of eradication control (histology, culture, rapid urease test or 13 C-urea test).[wjgnet.com]
  • What is the treatment for peptic ulcers? Can they be cured? The goal of ulcer treatment is to relieve pain, heal the ulcer, and prevent complications. The first step in treatment involves the reduction of risk factors (NSAIDs and cigarettes).[medicinenet.com]
  • Treatment The treatment of PUD and gastritis involves the following: 1.) If a cause is found: Removal of the cause e.g.: Eradication of H. pylori using antibiotics Discontinuation of NSAIDs 2. ) Therapy with anti-acid therapy.[kzngastro.co.za]
  • Fortunately, surgical therapy is rarely needed because of the efficacy of medical treatment.[gothamgastro.com]
  • What is the Treatment for Peptic Ulcer Disease? If you have been diagnosed with H.pylori infection, your doctor will prescribe a treatment plan to kill the infection and reduce the acid in your stomach.[maingastro.com]

Prognosis

  • Treatment and prognosis Treatment depends on the clinical presentation.[radiopaedia.org]
  • In the rare cases when surgery cannot be done, prognosis is poor. Gastric outlet obstruction Obstruction may be caused by scarring, spasm, or inflammation from an ulcer.[merckmanuals.com]
  • Prognosis The prognosis for recovery from ulcers is good for most patients. Very few ulcers fail to respond to the medications that are currently used to treat them. Recurrences can be eliminated completely or cut to 5% by eradication of H. pylori.[medical-dictionary.thefreedictionary.com]
  • It is an autosomal dominant disease with penetrance that is generally accepted to be 80%. [1] [20] Prognosis A 2009 study which followed 189 patients found no excess mortality despite the increased risk of pancreatic cancer. [21] References 1 2 Comfort[ipfs.io]
  • What is the prognosis for a person with peptic ulcer disease? With modern treatment, people with ulcer disease can lead normal lives without lifestyle changes or dietary restrictions.[medicinenet.com]

Etiology

  • […] arrive Mucosal cell replication 14 Disruption of Gastric Mucosal Barrier Fig 15 Peptic Ulcer Disease Etiology and Pathophysiology When blood flow is not sufficient, tissue injury results 16 Peptic Ulcer Disease Etiology and Pathophysiology Two mechanisms[slideplayer.com]
  • The more frequent etiologies are NSAIDs, aspirin, or Helicobacter pylori infection [ 3 ]. Other unusual causes exist; one of which is described in our case report.[pancreas.imedpub.com]
  • The etiology of duodenitis is not completely understood. However, the gastric acid hypersecretion and the helicobacter pylori play an important role in the pathogenesis. Brunner Gland Hyperplasia.[gastrointestinalatlas.com]
  • Causes and Incidence The precise etiologic mechanisms of peptic ulcer formation are unclear. However, recent research points to infection by Helicobacter pylori bacteria as the major factor in ulcer formation.[medi-info.com]

Epidemiology

  • Epidemiology It has a reported incidence of 1-4/1000, and is much more common in men (particularly duodenal ulcers- 5:1) Incidence has reduced in recent years due to widespread prescription of PPIs, awareness of NSAID use and risk, and eradication of[dundeemedstudentnotes.wordpress.com]
  • Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol. 2005; 40 :914–20. 3. Sharma SS, Mamtani MR, Sharma MS, Kulkarni H.[tropicalgastro.com]
  • Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion 2011; 84:102-113. 4. Williams N, Bullstrode C, Connell RO.[ejs.eg.net]
  • […] of 75 years and screening for early pancreatic cancer is being offered to HP sufferers on a scientific basis. [7] Some patients may choose to have their pancreas surgically removed to prevent pancreatic cancer from developing in the future. [8] The epidemiology[ipfs.io]
  • Epidemiology of perforated peptic ulcer : age- and gender –adjusted analysis of incidence and mortality. World J Gastroenterol. 2013;19(3):347-54. (PMID: 23372356) Sandzen B, Rosenmüller M, Haapamäki M.M, Nilsson E, Stenlund H.C, Oman M.[pancreas.imedpub.com]
Sex distribution
Age distribution

Pathophysiology

  • […] replication 14 Disruption of Gastric Mucosal Barrier Fig 15 Peptic Ulcer Disease Etiology and Pathophysiology When blood flow is not sufficient, tissue injury results 16 Peptic Ulcer Disease Etiology and Pathophysiology Two mechanisms that protect Mucus[slideplayer.com]
  • […] the levels of these hormones increase) This increases acid causes increased cell turnover in the duodenum, metaplasia and eventually ulceration, particularly in those with other risk factors (it is not certain whether gastric ulcers follow the same pathophysiology[dundeemedstudentnotes.wordpress.com]
  • Pathophysiology: The duodenal mucosa resists damage from theeffect of aggressive factors, such as gastric acid and theproteolytic enzyme pepsin, with the help of several protectivefactors such as a mucous layer, bicarbonate secretion, andprotective prostaglandins[gastrointestinalatlas.com]
  • As a nurse providing care to a patient with peptic ulcer disease, it is important to know the signs and symptoms, pathophysiology, medications, nursing management, diet education, and complications.[registerednursern.com]
  • Pyloric Stenosis Pathophysiology Edit Tobacco smoking, blood group, spices and other factors that were suspected to cause ulcers until late in the 20th century, are actually of relatively minor importance in the development of peptic ulcers. [4] A major[psychology.wikia.com]

Prevention

  • Original Article Jan 03, 2019 Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease Manson J.E., Cook N.R., Lee I.-M., et al.[nejm.org]
  • Eventually, we will understand how H.pylori is spread and how to prevent this infection. Meanwhile, the good news is that treatment programs are available to eliminate the infection and prevent duodenal recurrence.[maingastro.com]
  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.ro]
  • Its popular "5 books in 1" format provides quick reference to actionable guidance on diseases and disorders, differential diagnosis, clinical algorithms, laboratory evaluations, and clinical preventive services.[books.google.ro]
  • Here are facts about stomach ulcers and what you can do to treat or prevent painful stomach ulcers from occurring. WHAT ARE GASTRIC ULCERS? The word “ ulcer ” really means “sore” or “wound.”[healthfit24.com]

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