The patient was a 45 year-old male who presented with upper abdominal pain which was described as burning. On examination he was found to be anaemic and in shock.

1. Which organ is shown?

2. What is the nature of the lesion?

3. What important differential diagnosis needs to be excluded?

4. How is the condition diagnosed clinically?

5. What complications may occur?

ANSWERS

1. The stomach is shown.
2. There is an ulcer present characterized by a loss of the mucosa and a necrotic base.
3. The most important factor is to distinguish a malignant ulcer from a benign one. In a benign ulcer the margins are flat and the base is relatively clean. The ulcer is sharply defined and measures less than 3cm in diameter. By contrast a malignant ulcer often has a larger size, a ragged base and irregular edges. These factors however are not absolute so it is therefore mandatory that every gastric ulcer has a biopsy performed to exclude the presence of a malignant ulcer.
4. The ulcer can be diagnosed by a barium swallow which will fill the ulcer area but more recently the use of endoscopy provides a rapid and safe means of diagnosing gastric ulcers.
5. Similar complications to duodenal ulcers are present. There may be (i) bleeding, (ii) perforation, (iii) stenosis due to fibrosis (iv) penetration to cause acute pancreatitis and (v) malignant change – this is questionable factor as to whether ulcers are a significant predisposing factor as many believe that the ulcer was malignant from the beginning.

Ulcers may also be produced by various types of stress: Cushing’s ulcer – ulcer complicating intracranial disease. Curling’s ulcer seen in burns and steroid induced ulcers.