Page 424 - First Aid for the USMLE Step 1 2020, Thirtieth edition [MedicalBooksVN.com]_Neat
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380 seCtion iii Gastrointestinal ` gastrointestinal—PatHology Gastrointestinal ` gastrointestinal—PatHology
Peptic ulcer disease
Gastric ulcer Duodenal ulcer
Pain Can be Greater with meals—weight loss Decreases with meals—weight gain
H PYLORI inFeCtion ~ 70% ~ 90%
meCHanism mucosal protection against gastric acid mucosal protection or gastric acid secretion
otHer CaUses NSAIDs Zollinger-Ellison syndrome
risK oF CarCinoma Generally benign
otHer Biopsy margins to rule out malignancy
Ulcer complications
Hemorrhage Gastric, duodenal (posterior > anterior). Most common complication.
Ruptured gastric ulcer on the lesser curvature of stomach bleeding from left gastric artery.
An ulcer on the posterior wall of duodenum bleeding from gastroduodenal artery.
Obstruction Pyloric channel, duodenal.
Perforation Duodenal (anterior > posterior).
Anterior duodenal ulcers can perforate into the anterior abdominal cavity, potentially leading to
A
pneumoperitoneum.
May see free air under diaphragm (pneumoperitoneum) A with referred pain to the shoulder via
irritation of phrenic nerve.
FAS1_2019_09-Gastrointestinal.indd 380 11/7/19 4:42 PM
