Symptoms of Acute Peptic Ulcer, Chronic Gastric and Duodenal Ulcer

Symptoms of Acute Peptic Ulcer

• Symptoms of acute peptic ulcers are usually of short duration.
• Slight attack of dyspepsia may go unnoticed.
• These ulcers are more often unrecognized when they cause hematemesis (vomiting of blood).
• Acute peptic ulcer may be the cause of hematemesis in both sexes in all ages.
• Occasionally an acute ulcer may perforate particularly when it occurs in the wall of the duodenum.
  Acute ulcers may progress to chronic ulceration.

Symptoms of Chronic Gastric Ulcer

1. Age- the patients are usually middle aged.
2. Sex- more common in males than in females.
3. Constitution- the patients are usually thin and anemic with J-shaped hypotonic stomach.
4. Periodicity is less marked.
   The attacks last several weeks followed by intervals of freedom from symptoms for 2-6mths.
5. Pain- it is strictly epigastric. Pain is boring or pricking in nature. When the ulcer penetrates, pain may radiate to the back.
   1. i.    Site- in gastric ulcer pain is complained of in the mid-epigastrium or slightly to its left.
   2. ii.   Relation with food- pain occurs almost immediately or any time up to 1½hr after meal as food irritates ulcer.
   3. iii.   Pain is not felt in empty stomach.
   4. iv.  Food does not relieve pain; on the contrary it aggravates pain.
   5. v.    Pain is not felt at night.
6. Vomiting- in more than half the cases vomiting is a notable symptom. It often occurs after food. It relieves the pain and may be self-induced.
7. Appetite- is good. But the patient is afraid to eat as this initiates pain.
8. Diet- these patients usually learn to avoid fried and spicy foods since this initiates pain immediately.
9. Weight- some loss weight is usually present.
10. Hemorrhage is less common than duodenal ulcer. Hematemesis is more common than melaena (blood in stools).
11. On examination- tenderness can be elicited in the mid-epigastric or slightly to the left of it.

Symptoms of Chronic Duodenal Ulcer

• Age- the patients are usually young adults or mid-adults (25-40yrs).
• Sex- males dominate though not as much as gastric ulcer.
• Constitution- the patients are healthy males with steer-horn stomach which is high in position.
• Periodicity is well marked. The attacks also last for several weeks with intervals of freedom from 2-6mths. Attacks usually appear in the spring and autumn.
• Pain- pain is more severe and spasmodic in character.
  • Site- in duodenal ulcer patient complains of pain on the trans-pyloric plane about 1inch to the right of the midline.
  • Relation with food- pain usually starts 2½-3 hrs after food when the stomach gradually pushes the food into duodenum and irritates ulcer.
  • Pain is very much felt in empty stomach which is called ‘hunger-pain’. Excess acid is not neutralized by food and irritates ulcer.
  • Food relieves pain as this dilutes acid.
  • Pain at dead of night is very characteristic. The patient gets up with pain, he takes biscuits and milk. He is relieved of pain and goes to sleep.
  • Vomiting is rare, unless pyloric stenosis complicates the procedure. More common is regurgitation of the acidic fluid into the mouth or pain behind the sternum due reflux esophagitis.
• Appetite is good and he eats frequently to avoid pain.
• Diet- as particular food does not initiate pain immediately; he usually does not avoid anything.
• Weight- some gain of weight is expected, as the patient learns to take food frequently.
• Hemorrhage is more common than in gastric ulcer. Melaena is more common than hematemesis.
• On examination- tenderness can be elicited at the duodenal point which is situated on the trans-pyloric plane 1inch right of the midline.

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