Peptic Ulcer Disease (PUD)
PUD refers to mucosal ulcerations in the stomach (gastric ulcers) or the duodenum (duodenal ulcers). It is an imbalance between aggressive factors (acid, pepsin, H. pylori, NSAIDs) and mucosal defense.
1. Clinical Differentiation
| Feature | Duodenal Ulcer | Gastric Ulcer |
|---|---|---|
| Pain Timing | Improves with meals (weight gain). | Worsens with meals (weight loss). |
| Pathophysiology | H. pylori (most common); increased acid. | NSAIDs, H. pylori, decreased mucosal protection. |
| Malignancy Risk | Very rare. | Significant (must biopsy). |
2. Exam Must-Knows
- Complications:
- Hemorrhage: Most common complication.
- Perforation: Leads to free air under the diaphragm (seen on X-ray as “pneumoperitoneum”); often involves the posterior wall of the duodenum (eroding into the gastroduodenal artery).
- Obstruction: Pyloric channel ulcers can lead to gastric outlet obstruction.
- Zollinger-Ellison Syndrome: Suspect this if ulcers are refractory to treatment or multiple/distal. Caused by a gastrin-secreting tumor (gastrinoma).
Pathology Board Hint: For board exams, always remember: Duodenal ulcers = better with food, Gastric ulcers = worse with food. Also, if a patient has a perforated ulcer with shoulder pain (due to phrenic nerve irritation by free air), think about posterior duodenal wall perforation.