Abdominal pain peptic ulcer disease

Localised upper abdominal pain is the most common symptom of peptic ulcer disease. The pain is relieved by antacids, proton pump inhibitors and H2 antagonists. The pain may or may not be relieved by food and is often v/orse during the night. Peptic ulceration may be accompanied by occasional vomiting, anorexia and weight loss. Diffuse abdominal pain is not a characteristic symptom of peptic ulcer disease. 

Moderate nausea, diarrhea, or abdominal pain can occur in patients taking omeprazole (13). There is an increased incidence of the severe interstitial and atrophic forms of gastritis, associated with moderate hypergastrinemia and hjrperplasia of the argyrophil cells (1). This is not necessarily an adverse effect it could represent the natural history of chronic gastritis associated with peptic ulcer disease. 

Amylase enters the blood largely via the lymphatics. An increase in hydrostatic pressure in the pancreatic ducts leads to a fairly prompt rise in the amylase concentration of the blood. Neither an increase in volume flow of pancreatic juice nor stimulation of pancreatic enzyme production will cause an increase in senm enzyme concentration. Elevation of intraductal pressure is the important determinant. Stimulation of flow in the face of obstruction can, however, augment the entry of amylase into the blood, as can disruption of acinar cells and ducts. A functional pancreas must be present for the serum amylase to rise. Serum amylase determination is indicated in acute pancreatitis in patients with acute abdominal pain where the clinical findings are not typical of other diseases such as appendicitis, cholecystitis, peptic ulcer, vascular disease or intestinal obstruction. In acute pancreatitis, the serum amylase starts to rise within a few hours simultaneously with the onset of symptoms and remains elevated for 2 to 3 days after which it returns to normal. The peak level is reached within 24 hours. Absence of increase in serum amylase in first 24 hours after the onset of symptoms is evidence against a diagnosis of acute pancreatitis (76). 

Abdominal pain accompanied by rapid weight loss, vomiting and constipation, and which is unbearable in nature requires referral to exclude peptic ulcers, diverticular disease and carcinoma. 

The movement of larval and adult parasites produces several pathological changes like inflammation of the cells, allergic reactions and eosinophilia. The clinical manifestations of the disease include attacks of diarrhea, diffused abdominal pain, epigastric discomfort and hunger pains, which may lead to false diagnosis of peptic ulcer. Heavy infections may cause malabsorption, flatulence and abdominal disten-... 

Hypotension is the major adverse effect of phentolamine reflex carSac stimulation may cause tachycardia, arrhythmias, and ischemic carSac events. GI stimulation may result in abdominal pain, nausea, and exacerbation of peptic ulcer. Phentolamine should be used with particular caution in patients with coronary artery disease or a history of peptic ulcer. 

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