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Medicine

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Liver & GIT

Question
14 out of 27
 

The most common site of a benign (peptic) gastric ulcer is: (LQ)



A Upper third of lesser curvature

B Greater curvature

C Pyloric antrum

D Lesser curvature near incisuraangularis

Ans. D Lesser curvature near incisuraangularis

Peptic Ulcer

A. Duodenal ulcers (DU) (Most common site = 1st part due) are much commoner than GU.

Duodenal ulcers are always benign but 1 to 2% of gastric ulcer can being malignant.

In India ratio of DU to GU is 95% to 5%.

Risk factors:

1. H. pylori (-90%);

2. Drugs (aspirin; NSAIDs; steroids).

3. Blood group O

4. Smoking.

5. ZES,

6. Hyperparathyroid

7. Cushing disease

8. Cirrhosis of liver

9. Polycythemia vera

10. COPD

Symptoms

Epigastric pain typically before meals or at night, (Hunger pain) relieved by eating, or drinking milk. 50% are asymptomatic; others experience recurrent episodes.

Signs: Epigastric tenderness, melena can be there.

Diagnosis:

1. Upper GI endoscopy. (Biopsy not needed) most common site is 1st part of duodenum

2. Test for H. pylori.

a. Urea breath test b. Rapid urease test. c. Gastric biopsy to see H. pylori by staining.

3. Measure gastrin concentrations if Zollinger-Ellison syndrome is suspected.

Extra Edge: H. pylori are gram negative bacteria. Only toxicogenic strain cause peptic ulcer.

Best Epidemiological marker is H. pylori Serology.

B. Gastric ulcer (Most common site prepyloric area (H-18th - 2441), Gastric acid output is normal or decreased!!! (H-18th – 2441)

1. NSAIDs

2. Reflux of duodenal contents (Bile acid reflux)

3. Delayed gastric emptying

4. Stress, eg neurosurgery (Cushing's ulcers) or burns (Curling's ulcers).

Symptoms:

1. Asymptomatic or epigastric pain (Pain increases on taking meals relieved by antacids)

2. Weight loss.

3. They are rare in fundus but usually occur in antrum.

Tests

1. Upper GI endoscopy biopsy is mandatory to exclude malignancy because It may be premalignant and repeat endoscopy after treatment is also mandatory.

Misoprostol is use as a preventive drug for NSIAD induce gastric ulceration. It is not use in acute BD.

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