Perforated Duodenal & Gastric Ulcers

Introduction:

Perforated duodenal and gastric ulcers are serious complications of peptic ulcer disease, characterized by the erosion of the lining of the stomach or duodenum, leading to a hole or perforation. This perforation allows stomach acid and digestive juices to leak into the abdominal cavity, resulting in peritonitis, a life-threatening condition that requires immediate medical attention.

Understanding Perforated Duodenal & Gastric Ulcers:

Peptic ulcers, including duodenal and gastric ulcers, are sores that develop in the lining of the stomach or duodenum due to the erosion of the protective mucosal barrier by stomach acid and the bacterium Helicobacter pylori. Perforation occurs when the ulcer penetrates through the entire thickness of the stomach or duodenal wall, leading to a rupture.

Characteristics of Perforated Duodenal & Gastric Ulcers:

• Location: Perforated ulcers can occur in the duodenum (duodenal ulcers) or the stomach (gastric ulcers).
• Severity: Perforated ulcers are considered medical emergencies due to the risk of peritonitis and sepsis.
• Symptoms: Common symptoms include sudden and severe abdominal pain, often localized to the upper abdomen, which may radiate to the back or shoulders. Other symptoms include nausea, vomiting, abdominal tenderness, rigidity, and guarding.
• Complications: Without prompt treatment, perforated ulcers can lead to peritonitis, septic shock, multiple organ failure, and death.

Causes and Risk Factors:

• Helicobacter pylori Infection: Infection with H. pylori bacteria is a major risk factor for the development of peptic ulcers, including perforated duodenal and gastric ulcers.
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Chronic use of NSAIDs such as aspirin, ibuprofen, and naproxen can increase the risk of peptic ulcers and perforation.
• Smoking: Tobacco smoking is associated with an increased risk of peptic ulcer disease and delayed ulcer healing.
• Alcohol Consumption: Excessive alcohol consumption can irritate the stomach lining and increase the risk of peptic ulcers.
• Stress: While stress does not directly cause ulcers, it can exacerbate symptoms and delay healing in individuals with existing ulcers.

Signs and Symptoms:

• Sudden and severe abdominal pain, often described as sharp or stabbing, which may worsen with movement or deep breathing.
• Abdominal tenderness, rigidity, and guarding upon palpation.
• Rebound tenderness, indicating peritoneal irritation.
• Nausea and vomiting, which may be bilious or contain blood.
• Distension and rigidity of the abdomen due to peritonitis.
• Tachycardia, hypotension, and signs of shock in severe cases.