Fact-sheet: Duodenal ulcer
Updated on 09/17/2021 at 12:16 PM
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Definition
Ulcer: loss of substance of the digestive wall extending into the muscularis Fibrous scar upon healing Epidemiology: -Prevalence: 8% (peptic ulcer disease) -Decreasing since the early 1990s -Duodenal ulcer more common than gastric ulcer (4/1) -Male predominance (sex ratio 3/1) Predisposing factors: -H. Pylori gastritis in 90% of cases -NSAIDs, aspirin -Smoking, alcohol, stress (ICU) Duodenal ulcer may heal and recur (60% at 1 year), and may be complicated by: bleeding, perforation (10%)
Clinical features
-Generalized acute peritonitis:
sudden, knife-like epigastric pain becoming diffuse, abdominal guarding,
nausea, vomiting, paralytic ileus
-Localized peritonitis if the ulcer is perforated and sealed off,
apyrexia
CT
Imaging: CT -Supramesocolic pneumoperitoneum (sometimes minimal), peri-lesional, subhepatic, and anterior subphrenic -Falciform ligament sign: gas outlining the falciform ligament -Duodenal bulb wall thickening, sometimes an ulcer niche, wall discontinuity -Intramural air bubbles -Indirect signs: intraperitoneal effusion (supramesocolic), peri-lesional fat stranding
Management
Treatment:
Surgical emergency!