Virtual Hospital: Radiology Resident Case of the Week: Peptic Ulcer Disease

Radiology Resident Case of the Week

Peptic Ulcer Disease

April 12, 1996

Marta Bogdanowicz, M.D.
Peer Review Status: Not reviewed

Clinical Sx:
pt presenting with right upper quadrant pain, that penetrated to her back. She described this as being independent of eating (time of meal, type of food...). Pt stated that she had been loosing a large amount of weight and that she felt that she had to keep eating at all times in order to maintain her weight. She reports having been very constipated over the last several years, and denied episodes of diarrhea. She has a small child and states that she feels constantly stressed by the day to day struggles with her child, as well as the strains of abdomenal pain and constipation. The patient has a psychiatric history of anxiety and depression.

A barium enema was scheduled and the patient was unable to complete the prep, secondary to nausea and vomitting. She was scheduled for an ultra sound of the right upper quadrant, and on the same day had her upper GI study.

Etiology/Pathophysiology
Over the past years the accepted pathophysiology of peptic ulcer disease has changed dramatically. Gastric ulcers are considered to be benign 95% of the time.

Causes:
1. stress
2. burns=curling ulcer
3. cerebral disease=cushing ulcer
4. uremia
5. severe prolonged illness
6. gastritis
7. steroid therapy
8. intubation
9. stasis ulcer proximal to pyloric / duodenal obstruction
10. HPT (25% with ulcer disease)

Pathophysiology:
disrupted mucosal barrier(Helicobacter pylori) with vulnerability to acid and secretion of large volume of gastric juice containing little acid.

incidence: 5:10,000 peak 55-65 years of age male to female 1:1

multiplicity: they are multiple in 2-8%(17-24% on autopsy) coexist with duodenal ulcers in 5-64% of cases gastric/duodenal = 1:3 in adult age group

abdominal pain in approximately 30% at night, 25% state that pain is brought on by food.

Pathology:

Miscellaneous

Imaging
upper GI series, spot film

DDX
ulcer disease

Key references
Dahnert, second edition, p.514

ACR Code

Keywords:
peptic ulcer disease

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