Complications

Haemorrhage. This is the most frequent complication. It may be manifested by haematemesis (blood vomiting) and tarry faeces (melaena). Among other causes of gastric haemorrhagel peptic ulcer is accounted for 15-25 per cent of patients. The patient general condition depends on the length and intensity of bleeding.

Perforation. Free perforation into peritonial cavity occurs in approximately 2-3% of patients. Signs of perforation are a sudden stabbing pain, the reflex collapse, acute abdomen, and progressive peritonitis (unless a timely surgical aid is given to the patient). The pain is felt beneath the xiphoid process or in the right hypochondrium. The abdominal wall is tense. The patient assumes a forced posture on his back; the tongue is dry and coated. The pulse is retarded.

Penetration. Extension of the ulcer crater beyond the gastric or duodenal wall into contiguous structure e.g. pancreas especially if ulcer is in posterior wall of duodenum. Less commonly ulcer may penetrate into liver, biliary tract or colon.

Stenosis or pyloric obstruction. Ulcers heal to leave scars. If the ulcer was in the pylorus, the cicatricial tissue may narrow the lumen and interfere with free passage of he gastric contents into the duodenum. First the narrowing is compensated for by hypertrophy of the gastric muscles, but later the stomach becomes distended, food stays inside it for a longer period. Patient presents with abdominal bloating, nausea, vomiting and weight loss. Patients complain of permanent pain, eructation with rotten egg wind, and profuse morning vomiting with food that was ingested several days ago. Constipation is alternated with diarrhea. In the presence pyloric stenosis peristaltic and antiperistaltic movements of the epigastrium can be seen.

Irritable bowel syndrome

Functional gastrointestinal disorders are defined as disorders of gut function in the absence of structural pathology. Irritable bowel syndrome is a function bowel disorder in which abdominal pain is associated with defaecation or a change in bowel habit with features of disordered defaecation and distension.

Irritable bowel syndrome encompasses a wide range of symptoms and single cause is unlikely. It is generally believed that most patients develop symptoms in response to psychosocial factors, altered gastrointestinal motility, altered visceral sensation or luminal factors.

Clinical features

The most common presentation is that of recurrent abdominal pain. This is usually colicky or “cramping”, is felt in the lower abdomen and is relived by defaecation. Abdominal bloating worsens throughout the day; the cause is unknown but it is not due to excessive intestinal gas. The bowel habit is variable. Most patients alternate between episodes of diarrhea and constipation. The constipated type tend to pass infrequent pellety stools, usually in association with abdominal pain. Those with diarrhoea have frequent defaecation but produce low-volume stools. Passage of mucus is common.

Despite apparently severe symptoms, patients do not lose weight and are constitutionally well. Many have other “functional” symptoms including dyspepsia, headaches, backache, poor sleep and chronic fatigue syndrome. Physical examination does not reveal any abnormalities.