PUD

 

Etiology:

  1. H. pylori, NSAIDs, smoking, Zollinger-Ellison, cocaine, varices

S & S:

  1. Classic presentation of PUD is epigastric pain  or dyspepsia.
     
  2. The pain of Gastric Ulcers   typically occurs immediately after eating.
     
  3. The pain of Duodenal Ulcers are usually  relieved by  food,  but returns in 1 ½ - 4hrs after eating.

The complications of  PUD  that are important to r/o in ER:

  1. Hemorrhage: presents as UGI Bleed (melena, hematochezia, hematemesis). Treatment c/w O2, IVF, UO monitor, EKG to R/O ischemia ( if this is present or pt experiences chest pain transfusion is indicated), H2-blockers or PPI, serial CBC. For diagnosis®Endoscopy.
     
  2. Perforation: presents with sudden onset of epigastric pain or non specific findings such as tachycardia, hypotension, altered MS. Pt is usually Guaiac (-)ve. For diagnosis ® Upright CXR. If  this is not conclusive ®lateral decubiti or 300ml of free air  via NGT - clamp it and shoot Xray in 10-15min. Occasionally, lateral Chest Xray may show "double arch" diaphragm. Treatment: NGT to evacuate gastric content, IVF, Antbx, Surgery consult STAT.
     
  3. Obstruction: presents with N/V. Ulcers may scar and cause pyloric obstruction giving  the picture of Gastric Outlet Obstruction on the Xray. "Splash" may be heard. Treatment: NGT, electrolyte replacement, H2-blockers, IVF,  Surgery consult.

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