Complications of gastric and duodenal ulcers

Surgery should be considered for all complications of gastric and duodenal ulcers.

Bleeding


 * manifests as haematemesis or melena
 * RF: ASA (acetylsalicyl acid), NSAID (non-steroidal anti-inflammatory drugs)
 * diagnosis: endoscopy

Penetration


 * gradual penetration through the entire wall into the surrounding area (duodenal ulcer into the pancreas)
 * inflammation occurs, adhesions may form
 * persistent pain, propagation to the back
 * X-ray: deep plug

CAVE!!! Unlike perforation, it does not penetrate into the free abdominal cavity.

Perforace


 * rapid penetration through the wall, not enough to form adhesions
 * into the free peritoneal cavity or into the covered space formed by adhesions
 * 15% occur without previous ulcer problems
 * severe pain - sudden, cruel, constant, uncontrollable
 * picture of acute abdomen (acute peritonitis), shock
 * X-ray native: free gas under the diaphragm
 * leukocytosis with leftward shift
 * Th: surgery
 * CAVE!!! contraindication: X-ray using barium slurry

Stenosis of the pylorus
 * rarely in duodenal or pyloric ulcers
 * based on oedema or fibrosis
 * feeling of fullness, vomiting of older contents, 1-3 times a day, large volume
 * exclude carcinoma (differential diagnosis)

Related articles

 * Painful epigastric syndrome
 * Gastroduodenal ulcer disease