Peptic ulcers and stomach cancer: Clinical (To be retired)


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Peptic ulcers and stomach cancer: Clinical (To be retired)

Gen Surg

Gen Surg

Preoperative evaluation: Clinical (To be retired)

Shock: Clinical (To be retired)

Postoperative evaluation: Clinical (To be retired)

Traumatic brain injury: Clinical (To be retired)

Neck trauma: Clinical (To be retired)

Chest trauma: Clinical (To be retired)

Abdominal trauma: Clinical (To be retired)

Peripheral artery disease

Peripheral artery disease: Pathology review

Peripheral vascular disease: Clinical (To be retired)

Chronic venous insufficiency

Leg ulcers: Clinical (To be retired)

Wound healing

Skin cancer: Clinical (To be retired)


Burns: Clinical (To be retired)

Zenker diverticulum

Boerhaave syndrome

Plummer-Vinson syndrome

Esophageal cancer

Esophageal disorders: Clinical (To be retired)

Esophageal surgical conditions: Clinical (To be retired)

Gastric dumping syndrome


Gastroparesis: Clinical (To be retired)

Gastroesophageal reflux disease (GERD): Clinical (To be retired)

Helicobacter pylori

Peptic ulcers and stomach cancer: Clinical (To be retired)

Zollinger-Ellison syndrome

GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review

Acid reducing medications

Appendicitis: Clinical (To be retired)

Hernias: Clinical (To be retired)

Abdominal pain: Clinical (To be retired)

Jaundice: Clinical (To be retired)

Gallbladder disorders: Clinical (To be retired)

Pancreatitis: Clinical (To be retired)

Multiple endocrine neoplasia: Pathology review

Gastrointestinal bleeding: Clinical (To be retired)

Gastrointestinal bleeding: Pathology review

Bowel obstruction: Clinical (To be retired)


Diverticular disease: Clinical (To be retired)

Diverticular disease: Pathology review

Inflammatory bowel disease: Clinical (To be retired)

Colorectal polyps

Colorectal cancer

Colorectal cancer: Clinical (To be retired)

Colorectal polyps and cancer: Pathology review

Hirschsprung disease

Clostridium difficile (Pseudomembranous colitis)

Anal conditions: Clinical (To be retired)

Nephroblastoma (Wilms tumor)

Benign prostatic hyperplasia

Prostate cancer

Prostate disorders and cancer: Pathology review

Kidney stones: Clinical (To be retired)

Anatomy clinical correlates: Breast

Benign breast conditions: Pathology review

Breast cancer: Clinical (To be retired)

Breast cancer: Pathology review

Congenital disorders: Clinical (To be retired)

Anatomy of the thyroid and parathyroid glands

Thyroid nodules and thyroid cancer: Clinical (To be retired)

Thyroid nodules and thyroid cancer: Pathology review

Hyperthyroidism: Clinical (To be retired)

Hyperthyroidism: Pathology review

Hypothyroidism and thyroiditis: Clinical (To be retired)

Hypothyroidism: Pathology review

Parathyroid conditions and calcium imbalance: Clinical (To be retired)


Peptic ulcers and stomach cancer: Clinical (To be retired)

USMLE® Step 2 questions

0 / 14 complete


USMLE® Step 2 style questions USMLE

of complete

A 56-year-old woman presents to the primary care physician with a chief complaint of post-prandial abdominal pain and dyspepsia. The patient reports the symptoms started approximately 3-4 weeks ago and have been worsening in intensity. The patient’s only other medical problem is osteoarthritis, for which she occasionally receives corticosteroid injections and recently started taking diclofenac daily. Current temperature is  37 °C (98.6 °F), pulse is 86/min, respirations are 16/min and blood pressure is 142/62 mmHg. Physical examination shows epigastric tenderness on palpation. Which of the following is the best initial management for this patient’s condition?  


Content Reviewers

Rishi Desai, MD, MPH


Anca-Elena Stefan, MD

Alex Aranda

Justin Ling, MD, MS

Peptic ulcers are deep erosions in the lining of the stomach or duodenum that lead to inflammation in the gastric or duodenal wall.

Sometimes, peptic ulcers develop acutely like after a toxic ingestion or ischemia, but more often the erosions are chronic, developing slowly over time.

Chronic ulcers are mostly benign, but they can sometimes develop into a malignant ulcer, termed stomach cancer, which is why an upper endoscopy with biopsy is essential to the diagnosis.

Chronic ulcers sometimes don’t cause any symptoms. When they do, the most common symptom is dyspepsia.

Dyspepsia includes epigastric pain related to eating food, early satiety, postprandial belching, and nausea.

With gastric ulcers, epigastric pain worsens when eating a meal because of the hydrochloric acid that’s produced in response to food.

With duodenal ulcers, epigastric pain is relieved while eating a meal, but it typically recurs 2 to 5 hours later or it can appear at night. That’s because with duodenal ulcers, Helicobacter pylori is involved in most cases and it increases the hydrochloric acid production by indirectly increasing gastrin production and when there’s no food to act as a buffer, the pain worsens.

Sometimes peptic ulcers can erode deep into the gastric and duodenal wall resulting in complications.

If an ulcer erodes into a blood vessel, then it can cause hematemesis or melena.

If there’s an ulcer in the pyloric antrum or in the duodenum, then it can cause gastric outlet obstruction. That can worsen the symptoms and even cause the individual to lose weight.


A peptic ulcer is an erosion or a break in gastric or/and duodenal mucosa. The most common causes of peptic ulcers are infection with a bacterium called Helicobacter pylori (H. pylori) and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. Symptoms of peptic ulcers include upper left abdominal pain, bloating, vomiting, nausea, and loss of appetite. Treatment involves a combination of medications, and sometimes surgery.

Moving on to stomach cancer, also known as gastric cancer, it is a type of cancer that begins in the lining of the stomach. Risk factors for stomach cancer include H. pylori infection, a diet high in smoked or salty foods, and a family history of stomach cancer. Symptoms of stomach cancer usually appear in advanced stages and include nausea, vomiting, unintended weight loss, diffuse abdominal pain, hematemesis or melena, and a sense of fullness in the upper abdomen after eating a small meal. Treatment of stomach cancer may involve surgery, chemotherapy, and/or radiation therapy.


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