Peptic ulcer physical examination

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Physical examination

In the initial evaluation look for:

• Signs of active blood loss:
  • Anemia: skin pallor, palpitations, tachycardia, hypotension, systolic murmur.
  • Hematemesis.
  • Melena.
  • Heme-positive stool.
• Weight loss (suggest cancer).
• Sings of acute abdomen (perforation):
  • Rebound tenderness
  • Board-like-abdomen
  • Hypoactive bowel sounds

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

• Patient 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 presents with hematemesis and melena.

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

HEENT

• Pallor on the lower conjunctiva can be seen.

Lungs

• Normal B/L 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

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