History and exam
Key diagnostic factors
common
abdominal pain
Dyspepsia, a chronic or recurrent abdominal pain or discomfort centered in the upper abdomen, is a common clinical feature.[52]
Commonly related to eating and is often nocturnal.
In patients with duodenal ulcers, pain may be severe and radiate through to the back as a result of penetration of the ulcer posteriorly into the pancreas.
uncommon
"pointing sign"
Patient can show site of pain with one finger.
Other diagnostic factors
common
epigastric tenderness
May occur on palpation of the abdomen.
uncommon
nausea or vomiting
Nausea is relieved by eating.
Vomiting occurs after eating.
May indicate pyloric stenosis.
early satiety
May indicate pyloric stenosis.
weight loss or anorexia
Patients may experience weight loss or anorexia.
diarrhea
May indicate Zollinger-Ellison syndrome.
symptoms of anemia
Gastric and duodenal ulcers may cause iron deficiency anemia. Symptoms generally include fatigue, pica (abnormal craving or appetite for nonfood substances such as dirt, ice, paint, or clay), and nail changes.
gastrointestinal bleeding
Bleeding may be either occult (stool heme test positive) or overt (hematemesis and/or melena). This is a complication of peptic ulcer disease.
hypotensive or septic shock
From gastrointestinal bleeding or perforation.
succussion splash
Rarely, a succussion splash may be heard in patients with pyloric stenosis (caused by gastric outlet obstruction).
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