GASTRIC AND DUODENAL ULCER. A gastric ulcer is situated towards the centre of the stomach or near the pyloric orifice. It is commoner in the female sex. A duodenal ulcer is situated in the duodenum just beyond the pyloric orifice and chiefly affects men. They are produced by the gastric juice which digests a damaged portion of the lining mucous membrane. The cause of this damage is not usually to be found, but sometimes bacteria conveyed by the blood-stream from some focus of in fection, or inflammation of the mucous membrane, are responsible. Rarer causes are the blood poisons resulting from burns of the skin, certain purpuric diseases and anaemias, or Bright's disease. A dilated artery or vein may cause thinning of the overlying mucous membrane and finally ulceration and rupture ; blockage of an artery by blood-clot, leading to death of a portion of mucous membrane, is a rare cause. An injury is the rarest cause of all.
An acute ulcer is one recently formed. It is single or multiple, varies in size from that of a split pea to about an inch in diameter, and may be quite superficial or extend right through all the coats of the stomach. Acute ulcers, if treated, heal in about three or four weeks, leaving small scars. Sometimes they gradually ex tend, become thickened, and adhere to adjacent structures, now constituting chronic ulcers.
Chronic ulcer is usually single, and varies in size from that of a sixpenny piece to an area covering a third of the stomach. The liver or pancreas may be exposed by its erosion; and, by con traction during the healing process, the pyloric orifice or duo denum may be obstructed, or an hour-glass contraction of the stomach produced. Such ulcers heal with great difficulty and frequently remain unhealed for years. At any time during its formation or existence acute or chronic ulcer may erode an artery and cause bleeding; or perforate through the stomach wall, with extrusion of the gastric contents into the body cavity giving rise to general peritonitis or a local abscess.
Chronic ulcer is characterised by attacks of pain and vomiting extending over a period of from two to twenty years. The attacks last a few weeks or months and are separated by intervals, in which the patient is quite free from symptoms, or may suffer from constant dyspepsia (indigestion). The pain, which is usually severe, is situated in the abdomen between the breast-bone and the navel, often covers quite a small area, which is tender to the touch, and may shoot through to the back.
In gastric ulcer it occurs from a half to two hours, and in duodenal ulcer up to seven hours, after food. In each case it may awake the patient during the night. The pain is relieved in most cases by eating food or by alkaline medicine. Vomiting is more common in gastric ulcer and relieves the pain. The remain ing symptoms are a feeling of fullness and repeating of wind and sour fluid. The bleeding in chronic ulcer is less profuse than in acute ulcer and commonly consists of dark clots and material like coffee-grounds. Perforation is more common in chronic than acute ulcer and more frequently leads to a local abscess. Stric ture of the pylorus gives rise to more severe pain and the vomiting of large amounts at infrequent intervals. A chronic ulcer may be seen in many cases by the X-rays.