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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