A 55-year-old man comes to the office due to recurrent abdominal discomfort. He also has bloating, a feeling of fullness, and indigestion. Vital signs are within normal limits, and abdominal examination is unremarkable. Fecal occult blood testing is positive. Gastrointestinal endoscopic procedures are performed and confirm the presence of an ulcer. The patient is told that the ulcer itself is very unlikely to be malignant based on its location. Which of the following is the most likely site of this patient's gastrointestinal ulcer?

Question

A 55-year-old man comes to the office due to recurrent abdominal discomfort.  He also has bloating, a feeling of fullness, and indigestion.  Vital signs are within normal limits, and abdominal examination is unremarkable.  Fecal occult blood testing is positive.  Gastrointestinal endoscopic procedures are performed and confirm the presence of an ulcer.  The patient is told that the ulcer itself is very unlikely to be malignant based on its location.  Which of the following is the most likely site of this patient's gastrointestinal ulcer?

Quizplus · Accepted Answer

11ec160b_3959_0794_9249_9f7e4b7dcd6a_MD0001_00 Gastrointestinal ulcers are defined as breaches of the alimentary tract mucosa that extend through the muscularis mucosae into the submucosa (or beyond). Those specifically designated as peptic ulcers are chronic lesions in areas exposed to acid/peptic juices, most commonly in the proximal duodenum, antral stomach, and gastroesophageal junction. Patients may present with epigastric discomfort, early satiety, and a positive fecal occult blood test. Almost all peptic ulcers are due to either Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs (NSAIDs). The vast majority (>95%) of duodenal ulcers occur within the first part of the duodenum; however, multiple or refractory ulcers beyond the duodenal bulb may be seen in patients with gastrinoma (non-beta islet cell tumor of the pancreas). Duodenal ulcers are very rarely malignant and do not require biopsy. Conversely, gastric ulcers (located within the stomach) can be malignant (eg, gastric adenocarcinoma) and must be biopsied for confirmation (Choice E). Gastric ulcers caused by H pylori infection are associated with an increased risk of gastric cancer, but duodenal ulcers related to this infection do not lead to a higher risk of duodenal carcinoma. (Choice B) Esophageal adenocarcinoma can appear as an ulcerated/exophytic lesion in the lower third of the esophagus and typically results from Barrett esophagus, chronic gastroesophageal reflux disease, obesity, and/or smoking. Esophageal squamous cell carcinoma appears as plaque-like thickening of the mucosa in the upper two-thirds of the esophagus that may become ulcerated. Major risk factors include smoking, alcohol consumption, and caustic injury. (Choices C and D) Carcinomas of the distal colon tend to be annular lesions that result in "napkin-ring" constriction of the bowel, with heaped-up edges and an ulcerated central region. Risk factors include advanced age, hereditary (eg, familial adenomatous polyposis) or sporadic colon cancer in the family, and inflammatory bowel disease. Educational objective: Duodenal ulcers are not associated with an increased risk of carcinoma in the same location. In contrast, ulcers located in the esophagus, stomach (gastric), and colon may be malignant, and biopsy is required. __________ References: A past history of gastric ulcers and Helicobacter pylori infection increase the risk of gastric malignant lymphoma. (http://www.ncbi.nlm.nih.gov/pubmed/16400189) The risk of gastric cancer in patients with duodenal and gastric ulcer: research progresses and clinical implications. (http://www.ncbi.nlm.nih.gov/pubmed/19065723)

A 55-Year-Old Man Comes to the Office Due to Recurrent