Common Stomach Ulcer Symptoms

Pain
Epigastric pain (dyspepsia), is present in 80-90% of patients. However, this complaint is not sensitive nor specific enough to serve as a reliable diagnostic criterion for peptic ulcer disease. The clinical history cannot distinguish duodenal from stomach ulcers accurately. Less than 1/4 of patients with dyspepsia have ulcer disease at endoscopy. In patients with NSAID-induced ulcers, up to half are asymptomatic.

Pain is typically well localized to the epigastric region and is not severe. It is usually described as gnawing, dull, aching, or “hunger-like”. Typical features of stomach ulcer pain are rhythmicity and periodicity. Rhythmicity means that the pain fluctuates in intensity throughout the day and night. Half of patients report relief of pain with food or antacids (especially duodenal ulcers) and a recurrence of pain 2-4 hours later. 2/3 of duodenal ulcers and 1/3 of stomach ulcers cause nocturnal pain that awakens the patient.

A change from a patient’s typical rhythmic discomfort to constant or radiating pain may reflect ulcer penetration or perforation. Most patients have symptomatic periods lasting up to several weeks with intervals of months to years in which they are pain-free (periodicity).

Other stomach ulcer symptoms
Nausea and anorexia may occur with gastric ulcers. Significant vomiting and weight loss are unusual with uncomplicated ulcer disease and suggest gastric outlet obstruction or gastric malignancy.

Physical findings
The physical examination is often unremarkable in uncomplicated peptic ulcer disease. Mild, localized epigastric tenderness to deep palpation may be present. Fecal occult blood testing is positive in one-third of patients.

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Introduction:
Pancreatitis is inflammation of the pancreas. The pancreas is a gland located behind the stomach. Its function is to release the hormones – insulin and glucagon (both are to control blood sugar level), as well as digestive enzymes that will help you digest and absorb food. Most of the time, the enzymes are only active after they reach the small intestine, where they are needed to digest food. When these enzymes somehow become active inside the pancreas, they digest the tissue of the pancreas. This causes swelling, bleeding, and damage to the pancreas.

Different type of pancreatitis:

• Acute pancreatitis
• Chronic pancreatitis

Acute Pancreatitis

Symptoms of acute pancreatitis:
The main symptom of pancreatitis is abdominal pain felt in the upper left side or middle of the abdomen.
Character of the pain:

• Upper abdominal pain spreading to the back
• May be worse within minutes after eating foods with high fat content
• Becomes constant and more severe, lasting for several days
• May be worse when lying on the back

Other symptoms that may occur with this disease include:

• Fever/Chills
• Looking ill
• Nausea and vomiting (prominent symptoms)
• Sweating

Signs of acute pancreatitis:

• Abdominal tenderness or mass
• Fever
• Low blood pressure (if internal bleeding or dehydration has occurred)
• Rapid heart rate
• Rapid breathing rate
• Reduced bowel sounds

Causes of acute pancreatitis:

• Alcohol (commonest)
• Autoimmune
• Gallstones (commonest)
• Idiopathic
• Hypercalcaemia (elevated calcium level in blood)
• hypertriglyceridaemia (elevated fats level in blood)
• hypothermia (low core body temperature)
• Medical procedure – endoscopic retrograde cholangiopancreatography
• Medications such as azathioprine, diuretics
• Mumps
• Steroids
• Trauma

Laboratory tests that can be done:

• Blood amylase level
• Serum blood lipase level
• Urine amylase level
• Complete blood count
• Comprehensive metabolic panel

Possible imaging tests: (usually unnecessary)

• Abdominal CT scan
• Abdominal MRI (most useful among the three)
• Abdominal ultrasound

Diagnosis of acute pancreatitis
The diagnostic criteria for pancreatitis are two of the following three features:

• Abdominal pain characteristic of acute pancreatitis
• Serum amylase and/or lipase ?3 times the upper limit of normal
• Characteristic findings of acute pancreatitis on CT scan

Treatment: (usually supportive)

• Pain medication
• Fluids given through a vein
• Stopping food or fluid by mouth to limit the activity of the pancreas

Prognosis:
Most cases go away in a week. However, some cases develop into a life-threatening illness.
The death rate can be high if there is:

• Hemorrhagic pancreatitis
• Heart, liver or kidney impairment
• Necrotizing pancreatitis

Pancreatitis can return. The likelihood of it returning depends on the cause.

Possible complications:

• Acute kidney failure
• Acute respiratory distress syndrome
• Buildup of fluid in the abdomen
• Heart failure
• High blood glucose
• Pancreatic cysts or abscesses
• Repeat episodes of acute pancreatitis can lead to chronic pancreatitis

Chronic Pancreatitis

Chronic pancreatitis is inflammation of the pancreas that does not heal or improve, leading to permanent damage. When scarring of the pancreas occur, the organ is no longer able to make the right amount of digestive enzymes. As a result, your body may be unable to digest fat and other important parts of food. Damage to the portions of the pancreas that make insulin may lead to diabetes. The condition is most often caused by alcohol abuse over many years. Repeat episodes of acute pancreatitis can also lead to chronic pancreatitis.

Symptoms of chronic pancreatitis:

• Fatty stools (malabsorption of the fats in food)
• Nausea
• Persistent abdominal pain

Causes of chronic pancreatitis:

• Alcohol (commonest)
• Gallstones (commonest)
• Cystic fibrosis
• Idiopathic (commonest)

Prognosis:
This is a serious disease that may lead to disability and death. Reducing alcohol intake can reduce the risk.

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Gastroesophageal reflux disease (GERD) is seen in healthy people. GERD is thought to have a multifactorial etiology rather than a single cause. Contributing factors include the caustic materials that are refluxed, a breakdown in the defense mechanisms of the esophagus and a functional abnormality that results in reflux.

Definition:

Gastroesophageal reflux disease may be defined as symptoms or tissue damage caused by acid reflux of gastric contents with or without esophageal inflammation. However, this definition can blur the distinction between healthy people and those with GERD because a mild degree of esophageal reflux is considered physiologic. Other accepted definitions of GERD include reflux esophagitis identified by endoscopic examination and histologic esophagitis identified by examination of tissue samples.

Clinical Features:

Typical symptoms of GERD and acid reflux are heartburn and regurgitation; atypical symptoms include odynophagia, dysphagia, chest pain, cough, and reactive airway disease. A diagnosis of functional heartburn is made when patients have symptoms of GERD but do not have abnormal acid reflux on 24-hr esophageal pH testing or changes consistent with reflux-induced injury on endoscopic examination.

GERD can usually be diagnosed clinically based on the presentation alone of heartburn and regurgitation, which may also include dysphagia. In the absence of classic symptoms, GERD becomes more difficult to diagnose.

Symptoms of chest pain (possible cardiac causes), dysphagia, odynophagia and weight loss (possible esophageal stricture or cancer), require more extensive investigation before the diagnosis of GERD can be established .

Differential diagnosis:

The differential diagnoses are from other cause of heart burn, dysphagia, and chest pain.

Investigations:

Response to Omeprazole
A recent study demonstrated a potential role for a proton pump inhibitor, omeprazole, in the diagnosis of GERD. The response of symptoms to omeprazole, in a dosage of 40mg per day for 14 days, was shown to be about as the specific and sensitive for the diagnosis of GERD as the results of 24-hour pH monitoring. Because of the efficacy of omeprazole in relieving reflux symptoms, failure to respond to this proton pump inhibitor warrants the investigation of other possible causes for a patient’s symptoms.

Radiologic Findings
Only one-third of patients with GERD have radiologic signs of esophagitis. Findings include erosions and ulcerations, strictures, hiatal hernia, thickening of mucosal folds and poor distensibility. Only a minority of patients with documented abnormal pH have radiographically evident esophagitis. Consequently, a radiographic study is not the test of choice for the diagnosis of GERD.

Endoscopy
Endoscopy is not sensitive for diagnosis of GERD itself. Only 50% of patient with GERD manifest macroscopic evidence on endoscopy. It is useful for diagnosis of the complicated case. Indications for esophageal endoscopy in patients with GERD are:

• dysphagia or odynophagia, persistent or progressive symptoms despite therapy,
• esophageal symptoms in an immunocompromised patient presence of mass,
• stricture or ulcer on upper gastrointestinal barium study,
• evidence of gastrointestinal bleeding or iron deficiency anemia,
• and at least 10 years of GERD symptoms (screen for Barrett’s esophagus).

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Interesting thing that I realised is that we should not prescribe hyoscine (commonly known as buscopan) together with metoclopramide (maxalon). The reason is because hyoscine is an anti-spasmodic medication which stops abdominal cramps, and metoclopramide has prokinetic properties which helps with gastric emptying (therefore, prevents vomitting).

When you take both of them together, their properties are negated and none of them works! Or they might not work as well as if you take either one on its own!

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