When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms would the nurse expect to see? Select all that apply.
A. Epigastric pain at night
B. Relief of epigastric pain after eating
C. Vomiting
D. Weight loss
Correct Answers: C and D.
Vomiting and weight loss are common with gastric ulcers. Gastric ulcers are a break in the mucosa of the stomach lining that penetrates through the muscularis mucosa and extends more than 5 mm in diameter. When alterations occur to the defense mechanisms of the stomach, it can cause changes in the gastric mucosa which will eventually result in erosion and then ulceration.
Option A: Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about one hour after eating. They often describe this pain as a sharp or burning type of pain that typically doesn’t radiate. The most common finding on the physical exam is epigastric tenderness.
Option B: Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating. The typical presentation of a patient with gastric ulcers is epigastric pain that is worse with eating. It often correlates with mild nausea and early satiety.
Option C: These symptoms may continue for weeks or months before patients seek medical help. Patients may present with upper GI bleeding. The clinician should ask if they are having any black tarry stools, hematemesis, coffee-ground emesis, or bright red blood per rectum.
Option D: Alarm symptoms should be recognized which would make the need for an EGD more urgent. Alarm symptoms include unintentional weight loss, bleeding, age over 50, nausea, and vomiting. If a gastric ulcer is present on EGD, biopsies of the mucosa surrounding the ulcer will be necessary to rule out gastritis, Helicobacter pylori infection, and malignancy.
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