Peptic ulcer physical examination

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2017 ACG Guidelines for Peptic Ulcer Disease
Guidelines for the Indications to Test for, and to Treat, H. pylori Infection
Guidelines for First line Treatment Strategies of Peptic Ulcer Disease for Providers in North America
Guidlines for factors that predict the successful eradication when treating H. pylori infection
Guidelines to document H. pylori antimicrobial resistance in the North America
Guidelines for evaluation and testing of H. pylori antibiotic resistance
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Guidelines for penicillin allergy in patients with H. pylori infection
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

Peptic ulcer disease patient appears in severe stress due to abdominal pain. Common physical examination findings of peptic ulcer disease include epigastric tenderness, tachycardia.Perforated peptic ulcer disease patient presents with classic triad of severe epigastric tenderness, tachycardia and abdominal rigidity. Clinical signs of perforated peptic ulcer comes in 3 stages: In the initial stage within first 2 hours, the patient presents with tachycardia, epigastric pain and cool extremities.In next 2 to 12 hours, the patient presents with lower right quadrant tenderness and abdominal rigidity. In more than 12 hours, the patient presents with abdominal distension, hypotension, and pyrexia with acute circulatory collapse.

Physical Examination

Appearance of the Patient

• Patients usually appear in severe distress due to severe abdominal pain

Vital Signs

• Patient has normal vital signs in initial stages of peptic ulcer
• In peptic ulcer perforations vital signs may include :
  • Tachycardia with regular pulse
  • Weak pulse
  • Low blood pressure with normal pulse pressure
  • High-grade fever is present at later stage of peptic ulcer perforation

Skin

• Pallor is present in patients presenting with hematemesis and melena

The hand of a person with severe anemia compared to one without (on the right) Source -James Heilman, MD - Own work

HEENT

• Pallor on the lower conjunctiva can be seen

Lungs

• Normal bilateral vesicular breath sounds

Heart

• S1 and S2 normal, no murmur/rubs/gallops

Abdomen

• Abdominal tenderness at the epigastrium
• Perforated peptic ulcer presents with:
  • Rebound tenderness
  • Decreased bowel sounds
  • Lower right quadrant tenderness
  • Abdominal rigdity
  • Abdominal distension