What are gastric and duodenal ulcers?

Gastric and duodenal ulcers are types of peptic ulcer. The main distinction is that they affect different parts of the digestive tract. A person could have both at the same time. Some causes of peptic ulcers include an excess of stomach acid, bacterial infection, and certain medications.

In this article, we look at what gastric and duodenal ulcers are and how a doctor diagnoses them. We also explore their causes and treatments, along with associated symptoms and risk factors.

What are gastric and duodenal ulcers?

Gastric and duodenal ulcers are peptic ulcers, which are open sores in the lining of the digestive tract.

Gastric ulcers form in the lining of the stomach.

Duodenal ulcers develop in the lining of the duodenum, which is the upper part of the small intestine.

Many people with peptic ulcers rely on medical treatment to relieve their symptoms. Peptic ulcers sometimes heal on their own, but they can recur if a person does not receive treatment.

Symptoms

Symptoms of gastric and duodenal ulcers are generally similar. The most common complaint is a burning pain in the stomach.

Duodenal ulcers may also cause abdominal pain a few hours after eating.

This pain tends to respond well to medications or foods that reduce stomach acid, but as the effects of these wear off, the pain usually returns.

Abdominal pain from a duodenal ulcer may be worse when the stomach is empty, for example, between meals, at night, or first thing in the morning.

Other common symptoms of peptic ulcers include:

• heartburn or indigestion
• feeling full, even when the stomach is empty
• bloating
• gas
• nausea

Some people with these ulcers develop intolerances for specific foods. These foods may make a person feel sick, or they may make ulcer-related symptoms worse.

Less common and more severe symptoms include:

• feeling lightheaded
• weight loss
• blood in the stool
• vomiting
• vomiting blood
• trouble breathing

Some people with peptic ulcers have no symptoms. A doctor may only discover the ulcer when checking for a different digestive disorder.

Anyone with symptoms of peptic ulcers should see a doctor. If symptoms are severe, seek urgent medical attention.

Causes

Peptic ulcers result from damage or erosion to the protective lining of the digestive tract.

The following issues can play a role:

• having too much acid in the stomach or digestive tract
• digestive imbalances
• problems with the lining that makes it more susceptible to damage

Bacterial infections and certain medications can also lead to peptic ulcers.

A person has a higher risk of developing a peptic ulcer if they have an overgrowth of Helicobacter pylori (H. pylori) bacteria in the digestive tract. This type of bacterial infection is common.

While an H. pylori infection does not cause symptoms in most people, it sometimes irritates the lining of the digestive tract, which can lead to peptic ulcers.

Long-term use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) can also damage or irritate the lining and increase the risk of peptic ulcers.

NSAIDS include many other-the-counter pain relievers, such as ibuprofen (Advil), naproxen (Aleve), and aspirin.

Risk factors

A person's genetics and lifestyle can also increase the risk of developing a peptic ulcer.

If close family members have peptic ulcers, a person may be more likely to develop them. Smoking tobacco products can also increase a person's risk.

Other risk factors include:

• being over the age of 70
• having a history of gastric or duodenal ulcers
• recently experiencing serious physical trauma

Beyond NSAIDs, other medications can also increase a person's risk of developing peptic ulcers, including:

• anticoagulants
• steroids
• selective serotonin reuptake inhibitors, or SSRIs

Doctors no longer think that alcohol, spicy foods, or rich foods cause ulcers. However, consuming them may make symptoms worse or slow the healing process.

The role of stress in the development of ulcers is uncertain. Some doctors believe that stress is a direct risk factor, while others do not.

In one small study, psychological stress increased the risk of developing peptic ulcers. However, the researchers believed that the link was partly indirect, that stress led to other risk behaviors, such as taking NSAIDs and smoking.

Diagnosis

Symptoms of peptic ulcers can be similar to those of other conditions, such as gallstones or gastroesophageal reflux disease, which is commonly called GERD. Receiving a correct diagnosis is essential.

A doctor may begin by asking about a person's medical history and current medications. They will also ask about symptoms and the location of any pain.

A variety of tests can help confirm a diagnosis. The doctor may test the blood, stool, or breath to check for signs of H. pylori infection.

The doctor may also perform an endoscopy to look for ulcers. This involves inserting a thin tube with an attached camera down a person's throat and into the stomach and upper small intestine.

In some cases, a doctor may also recommend a barium swallow test. This involves swallowing a liquid that contains barium. The barium helps the doctor see the intestinal tract more clearly on an X-ray of the abdomen.

Treatment

For most people, treatment will involve taking medications that either reduce the amount of acid in the stomach or protect the lining of the stomach and duodenum.

These medications may fall into the following categories:

• proton pump inhibitors (PPIs), including omeprazole, pantoprazole, and lansoprazole
• H2-receptor antagonists, including ranitidine, famotidine, and cimetidine
• protectants, such as sucralfate
• antacids, such as calcium carbonate and sodium bicarbonate

If an H. pylori infection is responsible for the ulcers, a doctor may prescribe antibiotics to kill the bacteria. They may also prescribe medications that help suppress excess stomach acid, such as PPIs.

If other medications, such as NSAIDs, have caused the ulcers, the doctor may prescribe a PPI or review the need for the drug.

Some doctors also recommend reducing or better managing levels of stress.

Complications

Untreated ulcers can cause complications.

Rarely, peptic ulcers can lead to a perforation, or hole, in the wall of the stomach or intestine.

A perforation can put a person at serious risk of infection in the abdominal cavity. The medical name for this infection is peritonitis.

If a person with peptic ulcers experiences sudden abdominal pain that grows worse, they should see a doctor immediately.

Also, inflammation from ulcers can block a portion of the digestive tract. This obstruction can cause a person to:

• feel full after eating little or no food
• regularly vomit
• lose weight or become malnourished

In addition, ulcers can cause internal bleeding. If this bleeding develops slowly, it can lead to anemia. Symptoms of anemia can include fatigue, pale skin, and shortness of breath.

If the bleeding is severe, a person may see blood in vomit or stools. Anyone with symptoms of severe internal bleeding should seek immediate medical attention.

Source: Medical News Today

What are the symptoms of anaphylactic shock?

Anaphylaxis shock is a dangerous and potentially life-threatening condition caused by an allergic reaction. Many people use the terms anaphylaxis and anaphylactic shock to refer to the same thing. Anaphylactic shock, however, is a complication of anaphylaxis that occurs when the blood pressure drops very low, and the blood has trouble circulating.

Allergies occur when a person's immune system overreacts to a harmless substance called an allergen. This reaction causes the body to release chemicals that lead to irritation and other symptoms. Usually, allergic reactions are minor, causing symptoms such as a rash or a runny nose.

When a person's immune system dramatically overreacts to an allergen, it may release chemicals that affect multiple systems in the body. This can throw the person into anaphylaxis. In some people, anaphylaxis can include anaphylactic shock.

Fast facts on anaphylactic shock:

• As with anaphylaxis, anaphylactic shock is a life-threatening emergency.
• People with a history of anaphylactic reactions are at risk of anaphylactic shock.
• People who have had anaphylactic reactions should always carry an epinephrine injector.

Symptoms of anaphylactic shock

Most people develop symptoms of anaphylaxis within a few minutes of eating or being exposed to an allergen.

Less frequently, symptoms develop several hours later. The most common symptoms of an anaphylactic reaction include:

• nose, mouth, skin, or stomach irritation, such as a rash, diarrhea, or congestion
• breathing difficulties or wheezing
• low blood pressure that can cause fainting, dizziness, or confusion
• swelling of the mouth, tongue, or throat
• swollen lips
• a choking sensation or trouble swallowing

In some people, anaphylactic shock occurs as well as anaphylaxis.

A person will experience symptoms related to low blood pressure and poor oxygen flow to their organs if they are in anaphylactic shock.

Someone in anaphylactic shock may also lose consciousness, lose bowel or bladder function, or experience chest pain.

Anaphylactic shock reactions are similar to other forms of medical shock. In someone experiencing a severe allergic reaction while in a life-threatening situation, it might not be possible to distinguish anaphylaxis from other causes of shock. In most people, however, the condition is easily detected because of recent exposure to an allergen.

Early signs

The early symptoms of anaphylactic shock vary and may initially seem relatively mild. They may include hives, itching, or a sense of dread.

People with a history of severe allergic reactions often have the same pattern of symptoms each time they react.

Early warning signs that a person may be going into anaphylactic shock include:

• turning blue or white
• swelling of lips or face
• grating, grainy cough
• wheezing
• breathing problems
• hives, particularly if over several areas

Treatment

An epinephrine injector is a primary treatment for people experiencing anaphylaxis.

Also called an EpiPen, these injectors carry a single dose of the hormone epinephrine.

Epinephrine reverses the action of substances produced during the allergic reaction. It can also prevent the body from going into shock or reverse the process of shock if it has already started.

The EpiPen is usually injected directly into the thigh and is only available with a prescription from a doctor.

People should call 911 if they are experiencing or suspect they may be experiencing an anaphylactic reaction.

It is not safe to treat anaphylaxis at home or be driven to the hospital. If a person delays treatment, it can be fatal. Treatment always begins with the administration of epinephrine.

In cases of severe anaphylactic shock, a person may need additional treatment. This may include the following therapies and medications:

• administration of oxygen therapy
• intubation with a tube hooked to a machine to help with breathing
• beta-agonist injection to reduce swelling in the respiratory tract
• antihistamines to reduce the severity of the allergic reaction
• vasopressors to narrow blood vessels and raise blood pressure if it becomes dangerously low
• corticosteroids to help block allergic reactions and reduce swelling
• IV fluids for low blood pressure

It is important for people with a history of anaphylactic reactions to know which substances or allergens trigger symptoms.

A doctor will typically recommend allergy testing. This is because people with a history of anaphylactic reactions to one substance may also have severe allergic reactions to other allergens. Avoiding these allergens can be lifesaving.

People who are allergic to substances that cannot be avoided, such as insect stings, may be able to prevent anaphylaxis with allergy treatment.

Desensitization, also known as immunotherapy or allergy shots, involves slow and steady exposure to tiny amounts of an allergen to reduce the risk of an allergic reaction.

People can ask for a referral to an allergist who can decide whether desensitization is an option.

What are the causes?

People have anaphylactic reactions because of allergies. The body produces proteins that can attack dangerous invaders, including viruses and bacteria.

A person with allergies produces immunoglobulin E (IgE) proteins in response to harmless substances. These substances trigger white blood cells called mast cells to release specific chemicals, often histamines that cause an allergic reaction.

Some allergens are more likely than others to cause such a reaction.

These common allergens may be:

• insect stings
• foods, including peanuts, walnuts, shellfish, and eggs
• latex
• medications, including penicillin, some anesthesia, and aspirin

However, any substance a person is allergic to can trigger an anaphylactic reaction.

Source: Medical News Today

What to do when someone is unconscious?

When someone becomes unconscious, it is essential to know what to do. Some simple first aid steps, such as checking their vitals and for signs of serious injury, can help a person until the emergency services arrive. If a person is not breathing, it may be necessary to perform CPR.

Unconsciousness is an unresponsive state. A person who is unconscious may seem like they are sleeping, but may not respond to outside events, such as loud noises or being touched or shaken.

Fainting is a type of unconsciousness that comes on suddenly and may only last a few seconds. Unconsciousness can last for much longer, and a person's vital signs can change. Seek immediate medical attention if a person's pulse becomes weak, or they stop breathing.

What to do first when a person is unconscious

When someone appears to be unconscious or unresponsive, the first thing to do is ask them if they are okay in a loud voice; then gently shake them, unless they appear to have a spinal cord injury. If they do not respond, follow these steps in this order:

• check their airway is open without signs of blockage, such as labored breathing or high-pitched breath sounds
• look for signs they are breathing
• check for a pulse or heartbeat

Next, call or have someone else call the emergency medical services, which is 911 in the United States, if the person:

• has no pulse or only a weak pulse
• does not appear to be breathing
• does not respond or regain consciousness within 1 minute
• seems to be severely injured or is bleeding heavily

When speaking to emergency services on the phone, do not hang up until told to do so.

Check the person's wrists and neck to see if they are wearing a first aid tag, as this can give some indication of why they may have lost consciousness. Share the information on the tag with emergency services.

First aid steps

Before acting, it is essential to determine whether the unconscious person is breathing or not, as this will inform what to do next.

If the person is breathing

If the person is still conscious but seems dazed, ask them basic questions, such as what their name and birthday is or what the date is today.

Wrong answers or an inability to answer may mean they are experiencing a change in mental status. Share this information with emergency medical services.

If it appears the person may have a spinal injury, leave them as they are. Take measures to keep their neck supported and still.

If the person is breathing and it is unlikely they have a spinal injury, roll them into the recovery position on their side. Adjust the person's legs, so their hips and knees form right angles. Tilt their head gently back to be sure their airway is open.

If the person is not breathing

If an unconscious person is not breathing, it may be necessary to move them carefully onto their back, while protecting their neck, so that they can receive cardiopulmonary resuscitation (CPR).

Call 911 before administering CPR.

Signs, such as moving, coughing, or breathing are good signs. If these signs are not there, continue giving CPR until the emergency assistance arrives.

If the person is bleeding

If the unconscious person is bleeding heavily, locate the injury and place strong, direct pressure on the wounded area to slow the flow of blood. If possible, apply a tourniquet above the bleeding area to slow the bleeding until emergency services arrive. To apply a tourniquet, wrap a cord or bandage tightly around the affected limb.

How to perform CPR

CPR is an emergency procedure used to assist someone when they stop breathing and have no pulse. It consists of giving chest compressions, which is the cardio part, and rescue breaths, which is the pulmonary part.

Only people with CPR training should perform the entire procedure. To reduce the chances of potential injury, anyone who has not had CPR training should only perform chest compressions in steps 1 to 7 in the instructions below and not the rescue breaths in steps 8 to 10. Chest compressions can still help circulate oxygen-rich to the body and brain.

Before beginning CPR, try to wake the person again by calling their name loudly and asking if they are okay.

If the person is still unresponsive, perform a head tilt to open the airway:

• Place one hand on their forehead and the fingers of your other hand under the tip of their chin.
• Then gently tilt their head back, which moves the tongue, so it does not block the airway.

If there is a suspicion of a spinal injury, perform a jaw thrust instead:

• Kneel near the top of the person's head with your hands on either side of the face.
• Gently lift the person's jaw with your fingertips without moving their neck.

When the person's airway is open, follow these steps to perform CPR:

1. Lay the person on their back on any flat, hard surface available. Protect their neck from large movements if it looks like they might have a spinal injury.

2. Kneel down next to their shoulders, so your torso is over their chest.

3. Put the palm and heel of your hand in the center of their chest.

4. Place your other hand directly on top of the first hand and interlock your fingers.

5. Keep your elbows straight, kneel up to bring your shoulders up over your hands for more strength in your upper body.

6. Using the weight and force from your upper body, push straight down on their chest, compressing the chest at least 2 – 2.4 inches for adults, then release the pressure. This is one compression.

7. Do sets of 30 compressions at the rate of 100–120 times per minute, which is about twice every second.

Only people with CPR training should follow the next steps:

8. Tilt the person's head back and lift their chin to maintain an open airway.

9. Pinch their nose and cover their open mouth with your open mouth, making an airtight seal.

10. Blow until you see their chest rise. This is one breath. Perform two breaths, letting the lungs relax and exhale in between breaths.

Continue with the pattern of 30 compressions and two breaths until the emergency services arrive.

 Source: Medical News Today