Peptic ulcer differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Peptic ulcer}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Peptic_ulcer]]
{{CMG}}; {{AE}} {{GRN}} {{MKK}}
{{CMG}}; {{AE}} {{GRN}} {{MKK}}  


==Overview==
==Overview==
Peptic ulcer disease must be differentiated from other causes of acute upper gastrointestinal bleeding such as [[esophageal varices]], [[Mallory-Weiss syndrome]], gastrointestinal cancer, [[arteriovenous malformations]], [[esophagitis]], and [[esophageal ulcer]].  Peptic ulcer disease must also be differentiated from [[gastroesophageal reflux disease]] (GERD), [[irritable bowel syndrome]], [[pancreatitis]], and [[Zollinger-Ellison Syndrome]].
Peptic ulcer disease must be differentiated from other causes of acute upper gastrointestinal bleeding such as [[esophageal varices]], [[Mallory-Weiss syndrome]], gastrointestinal cancer, [[arteriovenous malformations]], [[esophagitis]], and [[esophageal ulcer]].  Peptic ulcer disease must also be differentiated from [[gastroesophageal reflux disease]] (GERD,[[pancreatitis]], [[Zollinger-Ellison Syndrome]][[Gastroesophageal reflux disease|,cholelithiasis,gastric outlet syndrome,myocardial infaraction ,pleural empyema and]]  [[appendicitis]]


==Differentiating Peptic Ulcer from other Diseases==
==Differentiating Peptic Ulcer from other Diseases==
 
Peptic ulcer disease must be differentiated from other diseases that presents with epigastric pain such as [[Gastritis|gastritis,]] [[Gastroesophageal reflux disease|gastroesophageal reflux disease,acute pancreatitis,prmary biliary cirrhosis,cholelithiasis,gastric outlet syndrome,myocardial infaraction ,pleural empyema,acut]]<nowiki/>e [[appendicitis]] <ref name="pmid18753649">{{cite journal| author=Gralnek IM, Barkun AN, Bardou M| title=Management of acute bleeding from a peptic ulcer. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 9 | pages= 928-37 | pmid=18753649 | doi=10.1056/NEJMra0706113 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18753649  }} </ref><ref name="pmid11701581">{{cite journal| author=Dallal HJ, Palmer KR| title=ABC of the upper gastrointestinal tract: Upper gastrointestinal haemorrhage. | journal=BMJ | year= 2001 | volume= 323 | issue= 7321 | pages= 1115-7 | pmid=11701581 | doi= | pmc=PMC1121602 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11701581  }} </ref><ref name="pmid22200689">{{cite journal| author=Nelson DR, Teckman J, Di Bisceglie AM, Brenner DA| title=Diagnosis and management of patients with α1-antitrypsin (A1AT) deficiency. | journal=Clin Gastroenterol Hepatol | year= 2012 | volume= 10 | issue= 6 | pages= 575-80 | pmid=22200689 | doi=10.1016/j.cgh.2011.12.028 | pmc=PMC3360829 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22200689 }} </ref><ref name="pmid24480518">{{cite journal| author=Tsochatzis EA, Bosch J, Burroughs AK| title=Liver cirrhosis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9930 | pages= 1749-61 | pmid=24480518 | doi=10.1016/S0140-6736(14)60121-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24480518 }} </ref><ref name="pmid18328931">{{cite journal| author=Schuppan D, Afdhal NH| title=Liver cirrhosis. | journal=Lancet | year= 2008 | volume= 371 | issue= 9615 | pages= 838-51 | pmid=18328931 | doi=10.1016/S0140-6736(08)60383-9 | pmc=PMC2271178 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18328931 }} </ref><ref name="pmid18923172">{{cite journal| author=Kahrilas PJ| title=Clinical practice. Gastroesophageal reflux disease. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 16 | pages= 1700-7 | pmid=18923172 | doi=10.1056/NEJMcp0804684 | pmc=PMC3058591 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18923172 }} </ref><ref name="pmid18789939">{{cite journal| author=Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM et al.| title=American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. | journal=Gastroenterology | year= 2008 | volume= 135 | issue= 4 | pages= 1383-1391, 1391.e1-5 | pmid=18789939 | doi=10.1053/j.gastro.2008.08.045 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18789939 }} </ref><ref name="pmid23477993">{{cite journal| author=Bredenoord AJ, Pandolfino JE, Smout AJ| title=Gastro-oesophageal reflux disease. | journal=Lancet | year= 2013 | volume= 381 | issue= 9881 | pages= 1933-42 | pmid=23477993 | doi=10.1016/S0140-6736(12)62171-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23477993 }} </ref><ref name="pmid16410582">{{cite journal| author=Fox M, Forgacs I| title=Gastro-oesophageal reflux disease. | journal=BMJ | year= 2006 | volume= 332 | issue= 7533 | pages= 88-93 | pmid=16410582 | doi=10.1136/bmj.332.7533.88 | pmc=PMC1326932 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16410582 }} </ref><ref name="pmid6710074">{{cite journal| author=Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T| title=Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy. | journal=Scand J Gastroenterol | year= 1984 | volume= 19 | issue= 1 | pages= 31-7 | pmid=6710074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6710074 }} </ref><ref name="pmid25901896">{{cite journal| author=Sipponen P, Maaroos HI| title=Chronic gastritis. | journal=Scand J Gastroenterol | year= 2015 | volume= 50 | issue= 6 | pages= 657-67 | pmid=25901896 | doi=10.3109/00365521.2015.1019918 | pmc=4673514 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25901896 }} </ref><ref name="pmid16819502">{{cite journal| author=Sartor RB| title=Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis. | journal=Nat Clin Pract Gastroenterol Hepatol | year= 2006 | volume= 3 | issue= 7 | pages= 390-407 | pmid=16819502 | doi=10.1038/ncpgasthep0528 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16819502 }} </ref><ref name="pmid2789799">{{cite journal| author=Sipponen P| title=Atrophic gastritis as a premalignant condition. | journal=Ann Med | year= 1989 | volume= 21 | issue= 4 | pages= 287-90 | pmid=2789799 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2789799  }} </ref><ref name="pmid25133039">{{cite journal| author=Badillo R, Francis D| title=Diagnosis and treatment of gastroesophageal reflux disease. | journal=World J Gastrointest Pharmacol Ther | year= 2014 | volume= 5 | issue= 3 | pages= 105-12 | pmid=25133039 | doi=10.4292/wjgpt.v5.i3.105 | pmc=4133436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25133039 }} </ref><ref name="pmid17956071">{{cite journal| author=Ramakrishnan K, Salinas RC| title=Peptic ulcer disease. | journal=Am Fam Physician | year= 2007 | volume= 76 | issue= 7 | pages= 1005-12 | pmid=17956071 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17956071 }} </ref><ref name="pmid17985090">{{cite journal| author=Banasch M, Schmitz F| title=Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors. | journal=Wien Klin Wochenschr | year= 2007 | volume= 119 | issue= 19-20 | pages= 573-8 | pmid=17985090 | doi=10.1007/s00508-007-0884-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17985090 }} </ref><ref name="pmid15621988">{{cite journal| author=Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM| title=Gastric adenocarcinoma: review and considerations for future directions. | journal=Ann Surg | year= 2005 | volume= 241 | issue= 1 | pages= 27-39 | pmid=15621988 | doi= | pmc=1356843 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15621988 }} </ref><ref name="pmid21390139">{{cite journal| author=Ghimire P, Wu GY, Zhu L| title=Primary gastrointestinal lymphoma. | journal=World J Gastroenterol | year= 2011 | volume= 17 | issue= 6 | pages= 697-707 | pmid=21390139 | doi=10.3748/wjg.v17.i6.697 | pmc=3042647 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21390139 }} </ref>
*[[Acute upper gastrointestinal bleeding]]: PUD accounts for the majority of acute episodes of gastrointestinal bleeding<ref name="pmid18753649">{{cite journal| author=Gralnek IM, Barkun AN, Bardou M| title=Management of acute bleeding from a peptic ulcer. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 9 | pages= 928-37 | pmid=18753649 | doi=10.1056/NEJMra0706113 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18753649  }} </ref> (up to 40%)<ref name="pmid11701581">{{cite journal| author=Dallal HJ, Palmer KR| title=ABC of the upper gastrointestinal tract: Upper gastrointestinal haemorrhage. | journal=BMJ | year= 2001 | volume= 323 | issue= 7321 | pages= 1115-7 | pmid=11701581 | doi= | pmc=PMC1121602 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11701581  }} </ref>, but there are other causes:<ref name="pmid22534226">{{cite journal| author=Wilkins T, Khan N, Nabh A, Schade RR| title=Diagnosis and management of upper gastrointestinal bleeding. | journal=Am Fam Physician | year= 2012 | volume= 85 | issue= 5 | pages= 469-76 | pmid=22534226 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22534226 }} </ref>
<small>
**Esophageal varices: history of cirrhosis (and portal hypertension)
<div style="width: 80%;">
**Mallory-Weiss syndrome: history of repeated vomiting
{| class="wikitable"
**Gastrointestinal cancer: history of anorexia or weight loss, tobacco smoking and alcohol drinking.
! colspan="3" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the abdomen based on etiology
**Arteriovenous malformations: Painless bleeding in >70 years old patients, history of iron deficiency anemia.
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
**Esophagitis or esophageal ulcer: heartburn, indigestion, or dysphagia
! colspan="9" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical manifestations
**Dieulafoy ulcer: painless bleeding
! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
*[[Alpha-1 Antitrypsin Deficiency]] [[AATD]]: besides lung disease, liver disease (hepatitis, cirrhosis, and hepatoma) represents another clinical manifestation of AATD,<ref name="pmid21960536 [">{{cite journal| author=Stoller JK, Aboussouan LS| title=A review of α1-antitrypsin deficiency. | journal=Am J Respir Crit Care Med | year= 2012 | volume= 185 | issue= 3 | pages= 246-59 | pmid=21960536 [ | doi=10.1164/rccm.201108-1428CI | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21960536 }} </ref><ref name="pmid19553648">{{cite journal| author=Silverman EK, Sandhaus RA| title=Clinical practice. Alpha1-antitrypsin deficiency. | journal=N Engl J Med | year= 2009 | volume= 360 | issue= 26 | pages= 2749-57 | pmid=19553648 | doi=10.1056/NEJMcp0900449 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19553648 }} </ref> therefore those patients can present upper gastrointestinal bleeding and abdominal pain, in the context of altered liver function.<ref name="pmid22200689">{{cite journal| author=Nelson DR, Teckman J, Di Bisceglie AM, Brenner DA| title=Diagnosis and management of patients with α1-antitrypsin (A1AT) deficiency. | journal=Clin Gastroenterol Hepatol | year= 2012 | volume= 10 | issue= 6 | pages= 575-80 | pmid=22200689 | doi=10.1016/j.cgh.2011.12.028 | pmc=PMC3360829 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22200689 }} </ref>
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments
*[[Cirrhosis]]:<ref name="pmid24480518">{{cite journal| author=Tsochatzis EA, Bosch J, Burroughs AK| title=Liver cirrhosis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9930 | pages= 1749-61 | pmid=24480518 | doi=10.1016/S0140-6736(14)60121-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24480518 }} </ref><ref name="pmid18328931">{{cite journal| author=Schuppan D, Afdhal NH| title=Liver cirrhosis. | journal=Lancet | year= 2008 | volume= 371 | issue= 9615 | pages= 838-51 | pmid=18328931 | doi=10.1016/S0140-6736(08)60383-9 | pmc=PMC2271178 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18328931 }} </ref> chronic liver disease is often asymptomatic until complications occur, such as variceal bleeding, [[ascites]], primary [[peritonitis]], [[sepsis]] or hepatic [[encephalopathy]].
|-
*[[Gastroesophageal reflux disease]] [[(GERD)]]:<ref name="pmid18923172">{{cite journal| author=Kahrilas PJ| title=Clinical practice. Gastroesophageal reflux disease. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 16 | pages= 1700-7 | pmid=18923172 | doi=10.1056/NEJMcp0804684 | pmc=PMC3058591 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18923172 }} </ref><ref name="pmid18789939">{{cite journal| author=Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM et al.| title=American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. | journal=Gastroenterology | year= 2008 | volume= 135 | issue= 4 | pages= 1383-1391, 1391.e1-5 | pmid=18789939 | doi=10.1053/j.gastro.2008.08.045 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18789939 }} </ref><ref name="pmid23477993">{{cite journal| author=Bredenoord AJ, Pandolfino JE, Smout AJ| title=Gastro-oesophageal reflux disease. | journal=Lancet | year= 2013 | volume= 381 | issue= 9881 | pages= 1933-42 | pmid=23477993 | doi=10.1016/S0140-6736(12)62171-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23477993 }} </ref><ref name="pmid16410582">{{cite journal| author=Fox M, Forgacs I| title=Gastro-oesophageal reflux disease. | journal=BMJ | year= 2006 | volume= 332 | issue= 7533 | pages= 88-93 | pmid=16410582 | doi=10.1136/bmj.332.7533.88 | pmc=PMC1326932 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16410582 }} </ref> current definition is "a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications.” [[Heartburn]] and regurgitation are the cardinal symptoms of [[GERD]], but patients can often present [[dysphagia]] and chest pain. Less common symptoms include [[odynophagia]], sialorrhea, subxiphoid pain or nausea. Also, patients can present extraesophageal GERD-related syndromes, such as chronic cough, [[laryngitis]], [[asthma]] or erosion of dental enamel.
! colspan="5" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Symptoms
*[[Irritable bowel syndrome]]
! colspan="4" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Signs
*[[Pancreatitis]]
|-
*[[Zollinger-Ellison Syndrome]]
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Fever
 
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and chills
==Differential Diagnosis==
! align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal Pain
Peptic ulcer disease must be differentiated from:<ref name="pmid6710074">{{cite journal| author=Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T| title=Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy. | journal=Scand J Gastroenterol | year= 1984 | volume= 19 | issue= 1 | pages= 31-7 | pmid=6710074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6710074 }} </ref><ref name="pmid25901896">{{cite journal| author=Sipponen P, Maaroos HI| title=Chronic gastritis. | journal=Scand J Gastroenterol | year= 2015 | volume= 50 | issue= 6 | pages= 657-67 | pmid=25901896 | doi=10.3109/00365521.2015.1019918 | pmc=4673514 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25901896 }} </ref><ref name="pmid16819502">{{cite journal| author=Sartor RB| title=Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis. | journal=Nat Clin Pract Gastroenterol Hepatol | year= 2006 | volume= 3 | issue= 7 | pages= 390-407 | pmid=16819502 | doi=10.1038/ncpgasthep0528 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16819502 }} </ref><ref name="pmid2789799">{{cite journal| author=Sipponen P| title=Atrophic gastritis as a premalignant condition. | journal=Ann Med | year= 1989 | volume= 21 | issue= 4 | pages= 287-90 | pmid=2789799 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2789799 }} </ref><ref name="pmid25133039">{{cite journal| author=Badillo R, Francis D| title=Diagnosis and treatment of gastroesophageal reflux disease. | journal=World J Gastrointest Pharmacol Ther | year= 2014 | volume= 5 | issue= 3 | pages= 105-12 | pmid=25133039 | doi=10.4292/wjgpt.v5.i3.105 | pmc=4133436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25133039 }} </ref><ref name="pmid17956071">{{cite journal| author=Ramakrishnan K, Salinas RC| title=Peptic ulcer disease. | journal=Am Fam Physician | year= 2007 | volume= 76 | issue= 7 | pages= 1005-12 | pmid=17956071 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17956071  }} </ref><ref name="pmid17985090">{{cite journal| author=Banasch M, Schmitz F| title=Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors. | journal=Wien Klin Wochenschr | year= 2007 | volume= 119 | issue= 19-20 | pages= 573-8 | pmid=17985090 | doi=10.1007/s00508-007-0884-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17985090  }} </ref><ref name="pmid15621988">{{cite journal| author=Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM| title=Gastric adenocarcinoma: review and considerations for future directions. | journal=Ann Surg | year= 2005 | volume= 241 | issue= 1 | pages= 27-39 | pmid=15621988 | doi= | pmc=1356843 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15621988  }} </ref><ref name="pmid21390139">{{cite journal| author=Ghimire P, Wu GY, Zhu L| title=Primary gastrointestinal lymphoma. | journal=World J Gastroenterol | year= 2011 | volume= 17 | issue= 6 | pages= 697-707 | pmid=21390139 | doi=10.3748/wjg.v17.i6.697 | pmc=3042647 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21390139  }} </ref>
! align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
<div style="width: 85%;">
! align="center" style="background:#4479BA; color: #FFFFFF;" |GI Bleed
{|
! align="center" style="background:#4479BA; color: #FFFFFF;" |Hypo-
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
tension
! rowspan="2" |Diseases
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Guarding
! colspan="4" |History and Symptoms
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rebound Tenderness
! colspan="4" |Physical Examination
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel sounds
! colspan="4" |Laboratory Findings
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Lab Findings
! rowspan="2" |Other Findings
! align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|-
!Abdominal pain
! rowspan="9" align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal causes
 
! colspan="1" rowspan="9" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Inflammatory causes
!Dyspepsia
! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pancreato-biliary disorders
!Hematemesis
|-
!Melena
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute pancreatitis]]
!Physical Finding 1
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
!Physical Finding 2
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
!Physical Finding 3
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[Epigastric]]
!Physical Finding 4
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
!Lab Test 1
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
!Lab Test 2
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
!Lab Test 3
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
!Lab Test 4
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[amylase]] / [[lipase]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Primary biliary cirrhosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]/[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased AMA level, abnormal [[LFTs]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cholelithiasis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]/[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N to hyperactive for dislodged stone
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[gallstone]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Gastritis
! colspan="1" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Gastric causes
| style="background: #F5F5F5; padding: 5px;" |
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Peptic Ulcer Disease|Peptic ulcer disease]]
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Episodic[[Epigastric]]
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
* Gastric ulcer- [[melena]] and [[hematemesis]]
| style="background: #F5F5F5; padding: 5px;" |
* Duodenal ulcer- [[melena]] and [[hematochezia]]
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in perforated
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ascitic fluid
** [[LDH]] > serum [[LDH]]
** Glucose < 50mg/dl
** Total protein > 1g/dl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Air under [[diaphragm]] in upright [[CXR]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Upper GI [[endoscopy]] for diagnosis
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug induced dyspepsia
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastritis|Gastritis]]
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in chronic gastritis
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Gastrinoma
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastroesophageal reflux disease|Gastroesophageal reflux disease]]
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]]
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |GERD
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastric outlet obstruction|Gastric outlet obstruction]]
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]]
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Gastric adneocarcinoma
! rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intestinal causes
| style="background: #F5F5F5; padding: 5px;" |
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute appendicitis]]
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +in pyogenic appendicitis
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Starts in [[epigastrium]], migrates to RLQ
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in perforated appendicitis
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], [[decreased appetite]]
|-
|-
|Primary gastric lymphoma
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Extra-abdominal causes
|
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pulmonary disorders
|
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pleural empyema]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]/[[Epigastric]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
|Chronic pancreatitis
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cardiovascular disorders
|
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Myocardial Infarction]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in cardiogenic shock
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
|Celiac disease
! colspan="16" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Abbreviations:''' '''[[RUQ]]'''= Right upper quadrant of the abdomen, '''LUQ'''= Left upper quadrant, '''LLQ'''= Left lower quadrant, '''RLQ'''= Right lower quadrant, '''LFT'''= Liver function test, SIRS= [[Systemic inflammatory response syndrome]], '''[[ERCP]]'''= [[Endoscopic retrograde cholangiopancreatography]], '''IV'''= Intravenous, '''N'''= Normal, '''AMA'''= Anti mitochondrial antibodies, '''[[LDH]]'''= [[Lactate dehydrogenase]], '''GI'''= Gastrointestinal, '''CXR'''= Chest X ray, '''IgA'''= [[Immunoglobulin A]], '''IgG'''= [[Immunoglobulin G]], '''IgM'''=[[Immunoglobulin M]], '''CT'''= [[Computed tomography]], '''[[PMN]]'''= Polymorphonuclear cells, '''[[ESR]]'''= [[Erythrocyte sedimentation rate]], '''[[CRP]]'''= [[C-reactive protein]] 
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! rowspan="3" |Disease
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==References==
==References==
{{reflist|2}}
{{reflist|2}}
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[[Category:Differential diagnosis]]
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Latest revision as of 23:37, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Guillermo Rodriguez Nava, M.D. [2] Manpreet Kaur, MD [3]

Overview

Peptic ulcer disease must be differentiated from other causes of acute upper gastrointestinal bleeding such as esophageal varices, Mallory-Weiss syndrome, gastrointestinal cancer, arteriovenous malformations, esophagitis, and esophageal ulcer. Peptic ulcer disease must also be differentiated from gastroesophageal reflux disease (GERD,pancreatitis, Zollinger-Ellison Syndrome,cholelithiasis,gastric outlet syndrome,myocardial infaraction ,pleural empyema and appendicitis

Differentiating Peptic Ulcer from other Diseases

Peptic ulcer disease must be differentiated from other diseases that presents with epigastric pain such as gastritis, gastroesophageal reflux disease,acute pancreatitis,prmary biliary cirrhosis,cholelithiasis,gastric outlet syndrome,myocardial infaraction ,pleural empyema,acute appendicitis [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]

Classification of pain in the abdomen based on etiology Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Fever Rigors and chills Abdominal Pain Jaundice GI Bleed Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Abdominal causes Inflammatory causes Pancreato-biliary disorders
Acute pancreatitis + Epigastric ± ± N Increased amylase / lipase Ultrasound shows evidence of inflammation Pain radiation to back
Primary biliary cirrhosis RUQ/Epigastric + N Increased AMA level, abnormal LFTs
Cholelithiasis ± RUQ/Epigastric ± + + N to hyperactive for dislodged stone Leukocytosis Ultrasound shows gallstone Murphy’s sign
Gastric causes Peptic ulcer disease ± EpisodicEpigastric + in perforated + + N
  • Ascitic fluid
    • LDH > serum LDH
    • Glucose < 50mg/dl
    • Total protein > 1g/dl
Air under diaphragm in upright CXR Upper GI endoscopy for diagnosis
Gastritis ± Epigastric + in chronic gastritis
Gastroesophageal reflux disease Epigastric
Gastric outlet obstruction Epigastric ± Hyperactive
Intestinal causes Acute appendicitis + +in pyogenic appendicitis Starts in epigastrium, migrates to RLQ + in perforated appendicitis + + Hypoactive Leukocytosis Ultrasound shows evidence of inflammation Nausea & vomiting, decreased appetite
Extra-abdominal causes Pulmonary disorders Pleural empyema + ± RUQ/Epigastric N
Cardiovascular disorders Myocardial Infarction Epigastric + in cardiogenic shock N
Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndromeERCPEndoscopic retrograde cholangiopancreatographyIV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDHLactate dehydrogenaseGI= Gastrointestinal, CXR= Chest X ray, IgAImmunoglobulin AIgGImmunoglobulin GIgM=Immunoglobulin MCTComputed tomographyPMN= Polymorphonuclear cells, ESRErythrocyte sedimentation rateCRPC-reactive protein 



Disease Cause Symptoms Diagnosis Other findings
Pain Nausea

&

Vomiting

Heartburn Belching or

Bloating

Weight loss Loss of

Appetite

Stools Endoscopy findings
Location Aggravating Factors Alleviating Factors
Acute gastritis Food Antacids - Black stools -
Chronic gastritis Food Antacids - H. pylori gastritis

Lymphocytic gastritis

  • Enlarged folds
  • Aphthoid erosions
-
Atrophic gastritis Epigastric pain - - - - H. pylori

Autoimmune

Autoimmune gastritis diagnosis include:

Crohn's disease - - - - -
  • Mucosal nodularity with cobblestoning
  • Multiple aphthous ulcers
  • Linier or serpiginous ulcerations
  • Thickened antral folds
  • Antral narrowing
  • Hypoperistalsis
  • Duodenal strictures
GERD
  • Lower esophageal sphincter abnormalities
  • Spicy food
  • Tight fitting clothing

(Suspect delayed gastric emptying)

- - - - Other symptoms:

Complications

Peptic ulcer disease

Duodenal ulcer

  • Pain aggravates with empty stomach

Gastric ulcer

  • Pain aggravates with food
  • Pain alleviates with food
- - - Gastric ulcers
  • Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
  • Most ulcers are at the junction of fundus and antrum
  • 0.5-2.5cm

Duodenal ulcers

Other diagnostic tests
Gastrinoma - -

(suspect gastric outlet obstruction)

- - - Useful in collecting the tissue for biopsy

Diagnostic tests

Gastric Adenocarcinoma - - Esophagogastroduodenoscopy
  • Multiple biopsies are taken to establish the diagnosis
Other symptoms
Primary gastric lymphoma - - - - - - - Useful in collecting the tissue for biopsy Other symptoms

References

  1. Gralnek IM, Barkun AN, Bardou M (2008). "Management of acute bleeding from a peptic ulcer". N Engl J Med. 359 (9): 928–37. doi:10.1056/NEJMra0706113. PMID 18753649.
  2. Dallal HJ, Palmer KR (2001). "ABC of the upper gastrointestinal tract: Upper gastrointestinal haemorrhage". BMJ. 323 (7321): 1115–7. PMC 1121602. PMID 11701581.
  3. Nelson DR, Teckman J, Di Bisceglie AM, Brenner DA (2012). "Diagnosis and management of patients with α1-antitrypsin (A1AT) deficiency". Clin Gastroenterol Hepatol. 10 (6): 575–80. doi:10.1016/j.cgh.2011.12.028. PMC 3360829. PMID 22200689.
  4. Tsochatzis EA, Bosch J, Burroughs AK (2014). "Liver cirrhosis". Lancet. 383 (9930): 1749–61. doi:10.1016/S0140-6736(14)60121-5. PMID 24480518.
  5. Schuppan D, Afdhal NH (2008). "Liver cirrhosis". Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.
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