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Clinical Features
Most patients with peptic ulcer disease are asymptomatic, particularly
older individuals (≥60 years old). Epigastric pain is the most common symptom
of PUD among symptomatic patients. The pain of a duodenal ulcer usually occurs
2-5 hours after a meal, improves with food or antacids, and sometimes awakens the
patient at night. The pain of gastric ulcer occurs shortly after meals and is
commonly worsened by food intake. Other symptoms include indigestion, nausea and
vomiting, loss of appetite, inability to tolerate fatty foods, heartburn, early
satiety, bloating, belching, abdominal fullness, weight loss, retrosternal
chest discomfort, nocturnal pain, and postprandial distress. Nausea and
vomiting are commonly experienced by patients with prepyloric or pyloric
channel ulcers.
Alarm Features
Alarm features may be observed in complicated peptic
ulcer disease. Hematemesis, melena, hematochezia, anemia or orthostatic
hypotension may be secondary to GI bleeding. A patient with a
Glasgow-Blatchford score of ≤1 has a very low risk of rebleeding or mortality and
may not need hospital admission or inpatient endoscopy. Progressive dysphagia,
recurrent vomiting, abdominal pain, weight loss, and early satiety may be due
to gastric outlet obstruction. Anorexia or weight loss may suggest cancer.
Persistent upper abdominal pain radiating to the back may be due to penetration
of an ulcer into adjacent structures. Sudden onset of abdominal pain, fever,
spreading upper abdominal pain that is severe, and signs of an acute abdomen
may suggest perforation.
Khám thực thể
The
physical examination is typically indistinct, especially in patients with
uncomplicated PUD. Most patients may only have mild epigastric tenderness. Acute
abdomen (presence of abdominal rigidity, rebound tenderness or guarding) may be
present in patients with perforation. Peptic ulcer perforation presents with a
triad of tachycardia, acute abdominal pain and abdominal rigidity. Succussion
splash may be elicited in patients with gastric outlet obstruction. Pallor may
be observed in patients with hemorrhage.
Peptic Ulcer Disease_Intial Assessment