epigastric pain for 4 weeks (episodic (Peptic Ulcer (Gastric ulcer:…
epigastric pain for 4 weeks
HX: pain often after fatty meals
peaks over hours and resolves when gallbladder relaxes.
pain is constant without pain free intervals
N/V but no jaundice
Gastric ulcer: exacerbated by food and relieved by vomiting
Duodenal Ulcer: relieved by food
Hx: Malena, hematemesis. If perforation, causes peritonitis.
Multiple aetiologies: NSAIDs and steroids (drug hx), H.pylori, smoking. Can progress to malignancy
precursor to ulcers but mucosa intact
Hx: Mild dyspepsia. Screen for anaemia, weight loss, recent onset of symptoms, malena or hematemesis, dysphagia
Hx: acidic taste in mouth, worse by lying flat. May present more as retrosternal pain rather than epigastric pain
Stomach cannot empty itself of food in normal fashion
Hx: N/V, early satiety, cyclical or continuous. Bloating. Symptoms of vitamin or mineral deficiency
Aetiologies: idiopathic, diabetic, post-surgical
Typically lasts for days only so less likely
Hx: sudden onset. classically radiating to the back, relieved by bending forward. Frequent vomiting and persistant nausea.
PE: Bruising of flanks (Grey Turner's Sign) and bruising of umbilicus (Cullen's Sign) ==> indicates retroperitoneal haemorrage
May also have steatorrhoea and new/woresning diabetes (Type 3A)
Hx: constant epigastric pain radiating to the back. Likely to have obstructive jaundice if tumour of the head.
Hx: Epigastric pain in 80%. Indigestion, nausea, vomiting, dysphagia, postprandial fullness, loss of appetitie, Melena, Hematemesis, Weight Loss
PE: physical signs only in late cancer. succusion splash and palpable stomach. hepatomegaly. Sister Mary Joseph nodule (periumbilical metastasis). Signs of paraneoplastic syndromes such as acanthosis nigricans or circinate erythemas
Hx: Weighloss, hematemesis/melena/anaemia; restrosternal or epigastric pain; hoarseness, persistent cough, respi symptoms caused by aspiration
PE: typically normal unless mets to neck nodes (lymphadenopathy)