QuestionSBA
QuestionChoice
Epigastric pain usually starts 2-3 hours after eating and the symptoms can be relieved by eating.

This is because the pyloric sphincter closes after eating to digest the food in the stomach. When the sphincter is closed, acid does not reach the duodenum to irritate the ulcer.

Pain can often wake people from sleep and cause weight gain.

Peptic ulcers can be associated with stress which is suggested by this man's high-pressure job.
10005906
a
Duodenal Ulcer
QuestionChoice
Peptic ulcer disease represented in this case is treated with proton pump inhibitors (PPIs) for up to 8 weeks. If left untreated, these can rupture.

The presentation would be sudden abdominal pain which is severe and present all over the abdomen.

On examination, they can be shocked with tachycardia and low blood pressure. They will be very still to avoid the pain in the peritoneum.
10005910
e
Perforated Peptic ulcer
QuestionChoice
H.pylori is a bacterial infection of the stomach which erodes the mucosal layer and results in more acid production.

This can result in a gastric ulcer rather than a duodenal ulcer.

This infection with NSAID use is the main cause of gastric ulcers.
10005908
c
Helicobacter pylori
QuestionChoice
This describes small pouches that form from the lining of the intestine. This is a common condition that occurs with age.

It can be asymptomatic but occasionally can cause some abdominal discomfort, constipation and diarrhoea.

You would not usually expect to see this in someone as young as 45 and pain would usually be felt in the left lower quadrant of the abdomen.
10005909
d
Diverticulosis
QuestionChoice
Epigastric pain usually starts within an hour after eating.

This is because the pyloric sphincter closes after eating to digest the food in the stomach. When the sphincter is closed, acid accumulates in the stomach and causes irritation and pain.

More common in people >50 years old.

Associated with weight loss as people are reluctant to eat which makes the pain worse.

Can be associated with vomiting and haematemesis.
10005907
b
Gastric Ulcer
Concept
Chapter
2693
4052
Peptic ulcer disease
Topic
136
Gastroenterology
13728
45 year old male presents to the GP with 3-month history of epigastric pain and heartburn.

He says that the pain is constantly there but worsens when he hasn't eaten for a while.

He does not vomit and his bowels are normal.

He works as a lawyer and has been reluctant to book time off work to make this appointment. He is now getting concerned as he believes he is putting on weight.

Which is the most likely cause of his symptoms?
a