History and exam
Key diagnostic factors
common
abdominal pain
Dyspepsia, a chronic or recurrent abdominal pain or discomfort centred in the upper abdomen, is a common clinical feature.[49]
Commonly related to eating and is often nocturnal.
In patients with duodenal ulcers, pain may be severe and radiate through to back as a result of penetration of the ulcer posteriorly into the pancreas.
presence of risk factors
H pylori infection and chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) are the two strongest risk factors for peptic ulcer disease. About 90% of patients with duodenal ulcers and >70% with gastric ulcers have H pylori infection.[17][19] The incidence of ulcers in chronic NSAID users is about 20% compared with about 5% in non-users.[20] The risk of NSAID-induced ulcers increases with increasing age (>60 years), a history of peptic ulcer, high doses of NSAIDs and longer duration of use, H pylori infection, and concurrent use of corticosteroids, bisphosphonates, or other antithrombotic drugs.[21][22][23][24][25]
Other risk factors include smoking, increasing age, and a personal or family history of peptic ulcer disease.
uncommon
'pointing sign'
Patient can show site of pain with one finger.
Other diagnostic factors
common
epigastric tenderness
May occur on palpation of the abdomen.
uncommon
nausea or vomiting
Nausea is relieved by eating.
Vomiting occurs after eating.
May indicate pyloric stenosis.
early satiety
May indicate pyloric stenosis.
weight loss or anorexia
Patients may experience weight loss or anorexia. Urgent upper gastrointestinal endoscopy (within 2 weeks) is recommended for any patient aged ≥55 years who has weight loss together with any one of dyspepsia, upper abdominal pain, or reflux.[47]
diarrhoea
May indicate Zollinger-Ellison syndrome.
symptoms of anaemia
Gastric and duodenal ulcers may cause iron deficiency anaemia. Symptoms generally include fatigue, pica (abnormal craving or appetite for nonfood substances such as dirt, ice, paint, or clay), and nail changes.
gastrointestinal bleeding
Bleeding may be either occult (stool haem test positive) or overt (haematemesis and/or melaena). This is a complication of peptic ulcer disease.
hypotension or septic shock
From gastrointestinal bleeding or perforation.
succussion splash
Rarely, a succussion splash may be heard in patients with pyloric stenosis (caused by gastric outlet obstruction).
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