ULCERS DIAGNOSIS |
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Physical examination and
patient history
The diagnosis of peptic ulcers is rarely made on the basis of a
physical examination alone. The only significant finding may be mild
soreness in the area over the stomach when the doctor presses (palpates)
it. The doctor is more likely to suspect an ulcer if the patient has
one or more of the following risk factors:
Male sex
Age over 45
Recent weight loss, bleeding, recurrent vomiting, jaundice, back
pain, or anemia
History of using aspirin or other NSAIDs
History of heavy smoking
Family history of ulcers or stomach cancer.
Endoscopy and imaging studies
An endoscopy is considered the best procedure for diagnosing
digestive ulcers and for taking samples of stomach tissue for
biopsies. An endoscope is a slender tube-shaped instrument that
allows the doctor to view the tissues lining the stomach and
duodenum. Duodenal ulcers are rarely malignant. If the ulcer is in
the stomach, however, the doctor will take a tissue sample because
3–5% of gastric ulcers are malignant. Radiological studies are
sometimes used instead of endoscopy because they are less expensive,
more comfortable for the patient, and are 85% accurate in detecting
malignancies.
Laboratory tests
Blood tests
Blood tests usually give normal results in ulcer patients without
complications. They are useful, however, in evaluating anemia from a
bleeding ulcer or a high white cell count from perforation or
penetration. Serum gastrin levels can be used to screen for
Zollinger-Ellison syndrome.
Tests for Helicobacter pylori
It is important to test for H. pylori because almost all ulcer
patients who are not taking NSAIDs are infected. Noninvasive tests
include blood tests for immune response and a breath test. In the
breath test, the patient is given an oral dose of radiolabeled urea.
If H. pylori is present, it will react with the urea and the patient
will exhale radiolabeled carbon dioxide. Invasive tests for H.
pylori include tissue biopsies and cultures performed from fluid
obtained by endoscopy. |
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