LearningRadiology - Duodenla Ulcer

Duodenal Ulcer Disease

• 2-3 times more frequent than gastric ulcers

• 3:1 male:female ratio

Pathophysiology

• Excessive acidity in duodenum from

• Abnormally high gastric secretion

• Inadequate neutralization

Predisposing factors

• Steroids

• Severe head injury

• Post-surgical

• COPD

Location

• Bulbar (95%)

• Anterior wall– 50%

• Posterior wall– 23%

• Inferior fornix– 22%

• Superior fornix– 5%

• Postbulbar (3-5%)

• Majority on medial wall just proximal to ampulla

• Tendency for hemorrhage in 66%

• Male:female ration 7:1

X-ray

• Small round, ovoid or linear crater

• Kissing ulcers–ulcers opposite from each other on the anterior and posterior walls

• Giant duodenal ulcer–>3cm (rare) with higher morbidity and mortality

• May be mistaken for the duodenal bulb itself and missed

• Clover-leaf deformity–healed central ulcer of the bulb with four-leaf clover-like deformity remaining

Complications

• Hemorrhage 15% melena>hematemesis

• Perforation <10% anterior>posterior /may fistulize to GB

• Obstruction 5%

• Penetration <5% walled-off perforation