Ulcer - Gastric Or Duodenal (Peptic Ulcer Disease - PUD)

Your Path

  • Ulcer - Gastric or duodenal (Peptic Ulcer Disease - PUD)


  • Erosion of gastric mucosa, with resultant bleeding and pain
  • Most common cause of UGIB

Risk Factors

  • ETOH
  • H pylori
  • NSAIDs, steroids, other meds
  • Severe illness/stress (head trauma, burns, ICU stays)
  • Zollinger Ellison (ZE) - very rare; from gastrinoma (located in pancreas)


  • Range from painless to epigastric burning/discomfort to boring/gnawing severe pain
  • Sometimes radiates towards back
  • Can be acute or chronic
  • Can be better or worse w/food
  • Sometimes emesis, which can be frank blood or 'coffee grounds' (blood altered by acid)
  • Stools turn black/dark (melena)
  • With ZE, recurrent/progressive ulcers that are unexplained, diarrhea

Physical Exam Findings

  • Can have tachycardia, hypotension, and ill appearance - depending on volume of blood lost
  • Sometimes epigastic pain on palpation
  • Rectal exam often w/black stool, guaiac +
  • Search for stigmata of liver disease (jaundice, ascites, edema, splenomegaly, etc) to assess risk for varices/portal gastropathy--> usually causes painless and profound upper GI bleeding assoc w/portal htn