Complications of Peptic Ulcer Disease

Complications of peptic ulcer disease include bleeding, ulcer perforation, penetration, and gastric outlet obstruction.

Bleeding: Most common complication. Treat with fluid resuscitation to correct hypovolemia; blood transfusions as necessary; early, high-dose intravenous PPI.

Ulcer Perforation:

Perforation usually elicits a sudden, severe upper abdominal pain. The patient appears severely distressed, lying quietly with the knees drawn up and breathing shallowly to minimize abdominal motion. Pain may radiate to the top of the right shoulder or to both shoulders.In the second phase (usually 2 to 12 hours after onset), abdominal pain may lessen. Board-like abdominal rigidity. Plain x-ray or CT scan of the abdomen reveals free subdiaphragmatic air. Up to 40% of ulcer perforations seal spontaneously; treat with fluids, nasogastric suction,IV PPIs, antibiotics.

Penetration: Ulcer perforates into contiguous structures such as pancreas. The pain becomes more severe and constant, may radiate to the back. Treat with IV PPIs, surgery.

Gastric Outlet obstruction: Least common complication; Presents with new onset of early satiety, nausea, vomiting, increase of postprandial abdominal pain, and weight loss. Prolonged vomiting and poor fluid intake may lead to prerenal azotemia, hyponatremia, and a hypokalemic, hypochloremic metabolic alkalosis.

On physical examination, a succussion splash may be heard in the epigastrium, which indicates retained fluid in the stomach.

Diagnosis: Nasogastric aspiration of a large amount of foul-smelling fluid; Endoscopy

Treat with dilation of the gastric obstruction by hydrostatic balloons passed through the endoscope, surgery. Malignancy is a more common cause of gastric outlet obstruction and must be excluded.


Q: What is the most common complication observed in PUD? GI bleeding.

Q: What is the most common cause of ulcer-related death? Bleeding

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