Ulcer disease usually presents with pain. Duodenal ulcers classically have relief of pain with eating whereas gastric ulcers tend to be exacerbated by food. Both types of ulcers may be caused by ingestion of non-steroidal anti-inflammatory agents or aspirin-containing Compounds. Alcohol and smoking have been implicated in the pathogenesis of ulcer disease and continued use of both may inhibit an ulcer from healing once it has formed. Ulcers that occur near the gastric outlet can present with vomiting because the acute inflammatory reaction occurring at the pylorus may cause near complete obstruction. The physical examination of patients with ulcer disease is usually nondiagnostic except in the case of Perforation in which instance a patient would present with a board-like abdomen. If the ulcer bleeds, the patient may have hematemesis, melena or grossblood per rectum if the bleeding was vigorous enough. In cases of severe pain, patients should have a CBC to rule out anemia and a chest X-ray to rule out free air under the diaphragm if the pain was acute in onset. Esophagogastroduodenoscopy (EGD) is not indicated in the presence of Pneumoperitoneum and/or Peritonitis.
KeywordsDuodenal Ulcer Gastric Ulcer Subtotal Gastrectomy Gastric Outlet Obstruction Truncal Vagotomy
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