Clinical presentation of gastric ulcer
Gastric mucosa involvement has a number of specific features. The dominant sign is pain, localized predominantly in the epigastric region. The character and onset time of discomfort are directly determined by the topography of the defect.
- Cardia and posterior wall: this localization is typical for so-called "early pain". It occurs almost immediately after the patient has eaten. Sensations are often projected behind the sternum, which requires careful differential diagnosis. In addition, pain may radiate to the left shoulder.
- Lesser curvature: the pain attack is somewhat delayed. Patients report the onset of discomfort and pain within 15 to 60 minutes after eating.
In addition to pain, the disease is accompanied by pronounced dyspeptic symptoms. Patients are troubled by persistent nausea, heartburn, and eructation, which can be either plain air or ingested food. A tendency toward constipation is also characteristic.
Features of duodenal ulcer
When the process is localized in the duodenum, epigastric pain prevails in the vast majority (about 75%) of patients. However, the rhythm of this pain is cardinally different from gastric pain.
- "Late pain" — develops 1.5–3 hours after eating.
- "Hunger pain" — occurs on an empty stomach and forces the patient to look for food.
- "Night pain" — awakens the patient at night.
The most important diagnostic criterion is the fact that food intake in duodenal ulcer relieves the pain syndrome or significantly eases the patient's condition.
Another striking clinical marker is vomiting. It develops at the very height of the pain attack and brings the patient obvious relief, significantly reducing the severity of pain. Common dyspeptic complaints frequently include bloating, heartburn, eructation, and frequent constipation.
During physical examination, the doctor detects tenderness upon palpation of the epigastric region. In some cases, defensive tension of the abdominal wall muscles—défense musculaire—is determined.
Asthenovegetative syndrome
Regardless of the location of the ulcer defect, a prolonged course of the disease leads to the depletion of the nervous system reserves. This manifests as asthenovegetative syndrome, which significantly reduces the patient's quality of life.
Patients complain of severe general weakness and progressive decrease in performance. Regarding the cardiovascular system, autonomic imbalance manifests as a tendency to tachycardia and arterial hypotension.
Briefly: answers to topical questions
What are the complications of peptic ulcer disease?
The following main complications of peptic ulcer disease exist:
- Bleeding — occurs from eroded blood vessels. It leads to hematemesis and melena.
- Perforation — characterized by sudden "dagger-like" abdominal pain and the development of peritonitis.
- Penetration — a variant of perforation with ingrowth into an adjacent organ, where the bottom of the ulcer becomes the wall of the neighboring organ.
- Pyloric stenosis (scar-ulcerative pyloric stenosis) — in case of decompensation, it can lead to chlorhydropenic uremia.
- Malignancy — malignant degeneration of the ulcer.
"Early eating — stomach, hunger night — intestine." In gastric ulcer, pain starts almost immediately after lunch (or within an hour), while in duodenal involvement, the patient suffers from night and hunger pains that miraculously subside after a snack.
Class and exam questions
How does pain differ in cardiac ulcer versus lesser curvature ulcer?
When localized in the cardia, pain appears immediately after eating and may radiate to the left shoulder. In lesser curvature involvement, pain sensations are delayed and begin after 15–60 minutes.
What is the role of vomiting in duodenal ulcer?
Vomiting occurs at the peak of pain sensations. Its key feature is that it brings the patient noticeable relief and reduces the intensity of the pain syndrome.
What is défense musculaire in the context of peptic ulcer disease?
This is a reflex tension of the abdominal wall muscles that can be detected during abdominal palpation in patients with a duodenal ulcer.
What else to study on this topic
- Mechanisms of pain radiation in posterior gastric wall ulcers
- Pathogenesis of "hunger" and "night" pains
- Causes of asthenovegetative syndrome in gastrointestinal pathology
- Differential diagnosis of retrosternal pain in cardiac ulcers
- Relationship between vomiting and pain relief
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