القرحة الهضمية

Definition

A peptic ulcer is a break in the stomach or duodenal lining that goes deeper than the surface layer.

Causes

• H. pylori, the commonest
• NSAIDs and aspirin
• Smoking, and stress ulcers in critically ill patients

Symptoms

• Burning upper abdominal pain
• Duodenal ulcer: pain eases with food and returns hours later and at night
• Gastric ulcer: pain often worsens with food

Complications

• Bleeding: haematemesis or coffee-ground vomit, black stools
• Perforation: sudden severe pain and a rigid abdomen
• Gastric outlet obstruction

Diagnosis

Endoscopy, plus H. pylori testing (urea breath, stool antigen or biopsy).

Treatment

• Proton pump inhibitors
• Multi-drug H. pylori eradication, then confirm cure
• Stop NSAIDs and smoking

Nursing care

• Watch for bleeding and shock
• Teach about medication and avoiding irritant painkillers

Exam point

Sudden severe pain with a board-like abdomen in an ulcer patient usually means perforation needing surgery.