Causes
·
Stress
·
Burns=Curling
ulcer
·
Cerebral
disease=Cushing
ulcer
·
Steroid
therapy
·
Hyperparathyroidism
(25%
have
ulcer
disease)
Other facts
·
Multiple
in 2-8%
·
Coexistent
duodenal
ulcer
disease
in
5-42%;
duodenal:gastric
ratio=3:1
·
Multiple
postbulbar
duodenal
ulcers
should
suggest
Zollinger-Ellison
Location
·
Lesser
curvature
aspect
of body
and
antrum
usually
for
benign
ulcers
·
Benign
ulcers
also
occur on
posterior
wall;
not
usually
anterior
wall
·
May be
found in
proximal
half of
stomach
in
geriatric
patient
·
Almost
all
lesser
curvature
gastric
ulcers
<1cm are
benign
·
Greater
curvature
benign
ulcers
are
associated
with
considerable
mass
effect
which
erroneously
leads to
conclusion
of
malignancy
Two
prerequisites
for
diagnosis
of an
ulcer
·
Collection
·
Persistent
Radiographic
Signs of
a benign
gastric
ulcer
·
Ulcer
crater-collection
of
barium
on
dependent
surface
which
usually
projects
beyond
anticipated
wall of
stomach
in
profile
(penetration)
·
Hampton’s
line-1
mm thin
straight
line at
neck of
ulcer in
profile
view
which
represents
the thin
rim of
undermined
gastric
mucosa
Benign.
lesser
curvature
gastric
ulcer.
Red
arrows
point to
Hampton's
Line,
a thin,
straight
line at
neck of
ulcer in
profile
view
which
represents
the thin
rim of
undermined
gastric
mucosa.
The blue
arrows
point to
the
ulcer
mound,
a
smooth,
sharply
delineated
soft-tissue
mass
surrounding
a benign
ulcer.
Note how
the
ulcer
projects
beyond
the
confines
of the
expected
wall of
the
stomach.
Click here for
this photo
without
the
arrows
·
Ulcer
collar-smooth,
thick,
lucent
band at
neck of
ulcer in
profile
view
representing
thicker
rim of
edematous
gastric
wall
·
Ulcer
mound-smooth,
sharply
delineated
tissue
mass
surrounding
a benign
ulcer
·
Ring
shadow-thin
rim of
contrast
which
represents
an ulcer
on the
non-dependent
surface
of an
air-contrast
study
·
Thickened
folds
radiating
directly
to the
base of
the
ulcer en
face
Healing
·
Most
gastric
ulcers
clear
completely
in 6-8
weeks.
·
With
healing,
ulcer
decreases
in size
and is
more
likely
to
appear
linear
·
Radiating
folds
become
more
prominent
and
extend
to
crater
·
Between
50-90%
of
healed
gastric
ulcers
produce
visible
scars on
Double
Contrast
study
Radiographic
signs of
malignant
ulcers
·
Ulcer
projects
within
the
anticipated
wall of
the
stomach
·
Ulcer is
eccentrically
located
within
the
ulcer
mound
·
Irregularly
shaped
ulcer
crater
·
Nodular
ulcer
mound
·
Abrupt
transition
between
normal
and
abnormal
mucosa
several
cms away
from the
ulcer
crater
·
Rigidity,
lack of
distensibility
and lack
of
changeability
·
Associated
large
mass
·
Carmen
meniscus
sign-a
relatively
shallow
gastric
ulcerating
malignancy
projecting
as an
ulcer
which is
always
convex
inwards
to the
lumen
and
which
does not
project
beyond
the
wall=Kirklin
meniscus
complex
Complications
of ulcer
disease
·
Bleeding
is
slightly
more
common
in the
duodenum
than the
stomach
o
About
17% of
all
ulcers
are
complicated
by
bleeding
o
A
filling
defect
in the
ulcer
crater
may
represent
a blood
clot
·
Gastric
outlet
obstruction
is less
common
than
bleeding
(5%)
o
Stomach
may have
to be
suctioned
to get
good
study
o
Benign
ulcer
disease
at the
pylorus
is a
more
likely
to cause
gastric
outlet
obstruction
than ca
·
Perforation
in 5-11%
is more
common
in
duodenal
than
gastric
ulcers
o
Most
gastric
perforations
are from
lesser
curve
ulcers
o
Free air
is not
detected
by x-ray
in
25-35%
of
perforated
duodenal
ulcers
·
Penetration
is the
extension
of the
ulcer
beyond
the
serosa
in to
adjacent
structures
o
Pancreas
is most
common
site,
but also
biliary
tree,
colon
