Common aetiological factors
- H.pylori - 90% duodenal ulcers, 70% gastric ulcers
- NSAIDS - systemically suppress (protective) prostaglanding production
- Systemic illness - leading to stress ulcers: Curling's in burns / Cushing's in trauma
- Cigarette smoking
- Chronic disease
Complications of peptic ulceration
- Perforation (anterior wall ulcers - cause peritonitis): needs oversewing
- Haemorrahge (posterior wall ulcers - erode gastoduodenal artery): needs under-running
- Gastric outlet obstruction (duodenal ulcers - stricture of first part of duodenum)
- Recurrent ulceration
Confirmation of perforated peptic ulcer
- History - risk factors (smoking, medications)
- Examination - rigid abdomen, peritonitis, absent bowel sounds (may be no clinical signs in elderly)
- CXR - free air under diaphragm (85% of cases)
- Serum amylase to exclude pancreatitis
- ECG to exclude MI