(4) Gastric peptic ulcer. A gastric ulcer is an open lesion located close to
the pyloric antrum (the lesser curve of the stomach). A gastric ulcer is caused by a
break in the peptic epithelium (the lining of the digestive organs). Unlike the duodenal
ulcer, the gastric ulcer is not associated with too much acid in the stomach or with the
emptying time of the stomach. What happens in this disorder is that regurgitation (a
backward flowing) of digestive contents into the stomach contains bile salts. These
salts lead to the destruction of the surface mucus of the stomach. Particular drugs such
as aspirin and cortisone cause the stomach lining to be less resistant to acid. Also,
alcohol and caffeine increase the secretion of acids. Eating sometimes actually causes
rather than relieves pain. Many gastric ulcers have no symptoms, but when there is
pain, it is located in the upper portion of the stomach, often to the left of the midline.
Also, medical treatment does not usually stop the symptoms. Vomiting is more
common with gastric ulcers than with uncomplicated duodenal ulcers. The incidence of
gastric ulcers is about the same for women as for men. Unlike duodenal ulcers, gastric
ulcers can become malignant.
(5) Complications of peptic ulcers. The most important complications of
peptic ulcers are hemorrhage, perforation, penetration, and obstruction. Eventually,
these complications generally require surgical treatment.
(a) Hemorrhage. Hemorrhage is the most frequent complication of a
peptic ulcer. Hemorrhaging (heavy bleeding) occurs when the walls of a blood vessel
are worn away by the ulcer. If the blood vessel is large, massive bleeding results. If the
blood vessel is small or not fully opened, there may be small seepage of blood which is
not noticeable. Seepage of blood may not be noticeable until enough blood has been
lost for the patient to exhibit signs and symptoms of hemorrhage: chills, thirst, cold,
moist skin, and a desire to defecate. The patient may pass black, tarry stools (melena)
or vomit blood (hematemesis). The blood which is vomited is either bright red or dark
with the consistency of coffee grounds. Bleeding high in the gastrointestinal tract
produces black, tarry stools. Bleeding near the anus (for example, hemorrhoids) is
bright red mixed with the stool. A person suffering from a massive hemorrhage will
exhibit these signs and symptoms with a rapid decrease in body blood volume go into
profound shock. His pulse will be rapid and weak, and his blood pressure may drop to
80 mm. or less. Pale skin, thirst, faintness, sweating, and eventually collapse also
characterize massive hemorrhage. This patient needs blood transfusions, intravenous
feedings, and rest until the bleeding has stopped.
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