Causes of Ulcer

Causes of Ulcer: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Ulcer.

Dyspepsia: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Cholelithiasis.

Dyspepsia may occur with gallstones, usually after eating fatty foods. Biliary colic, a more common symptom of gallstones, causes acute pain that may radiate to the back, shoulders, and chest. The patient may also have diaphoresis, tachycardia, chills, a low-grade fever, petechiae, bleeding tendencies, jaundice with pruritus, dark urine, and clay-colored stools.

Cirrhosis

With cirrhosis, dyspepsia varies in intensity and duration and is relieved by taking an antacid. Other GI effects are anorexia, nausea, vomiting, flatulence, diarrhea, constipation, abdominal distention, and epigastric or right upper quadrant pain. Weight loss, jaundice, hepatomegaly, ascites, dependent edema, a fever, bleeding tendencies, and muscle weakness are also common. Skin changes include severe pruritus, extreme dryness, easy bruising, and lesions, such as telangiectasis and palmar erythema. Gynecomastia or testicular atrophy may also occur.

Duodenal ulcer

A primary symptom of a duodenal ulcer, dyspepsia ranges from a vague feeling of fullness or pressure to a boring or aching sensation in the middle or right epigastrium. It usually occurs 1.5 to 3 hours after a meal and is relieved by eating food or taking an antacid. The pain may awaken the patient at night with heartburn and fluid regurgitation. Abdominal tenderness and weight gain may occur; vomiting and anorexia are rare.

Gastric dilation (acute)

Epigastric fullness is an early symptom of gastric dilation, alife-threatening disorder. Accompanying dyspepsia are nausea and vomiting, upper abdominal distention, succussion splash, and apathy. The patient may display signs and symptoms of dehydration, such as poor tissue turgor and dry mucous membranes, and of electrolyte imbalance, such as an irregular pulse and muscle weakness. Gastric bleeding may produce hematemesis and melena.

Gastric ulcer

Typically, dyspepsia and heartburn after eating occur early in gastric ulcer. The cardinal symptom, however, is epigastric pain that may occur with vomiting, fullness, and abdominal distention and may not be relieved by eating food. Weight loss and GI bleeding are also characteristic.

Gastritis (chronic)

With chronic gastritis, dyspepsia is relieved by antacids; lessened by smaller, more frequent meals; and aggravated by spicy foods or excessive caffeine. It occurs with anorexia, a feeling of fullness, vague epigastric pain, belching, nausea, and vomiting.

GI cancer

GI cancer usually produces chronic dyspepsia. Other features include anorexia, fatigue, jaundice, melena, hematemesis, constipation, and abdominal pain.

Heart failure

Common with right-sided heart failure, transient dyspepsia may occur with chest tightness and a constant ache or sharp pain in the right upper quadrant. Heart failure also typically causes hepatomegaly, anorexia, nausea, vomiting, bloating, ascites, tachycardia, jugular vein distention, tachypnea, dyspnea, and orthopnea. Other findings include dependent edema, anxiety, fatigue, diaphoresis, hypotension, a cough, crackles, ventricular and atrial gallops, nocturia, diastolic hypertension, and cool, pale skin.

Hepatitis

Dyspepsia occurs in two of the three stages of hepatitis. The preicteric phase produces moderate to severe dyspepsia, a fever, malaise, arthralgia, coryza, myalgia, nausea, vomiting, an altered sense of taste or smell, and hepatomegaly. Jaundice marks the onset of the icteric phase, along with continued dyspepsia and anorexia, irritability, and severe pruritus. As jaundice clears, dyspepsia and other GI effects also diminish. In the recovery phase, only fatigue remains.

Hiatal hernia

Dyspepsia is a result of the lower portion of the esophagus and the upper portion of the stomach rising into the chest when abdominal pressure increases.

Pulmonary embolism

Sudden dyspnea characterizes pulmonary embolism, a potentially fatal disorder; however, dyspepsia may occur as an oppressive, severe, substernal discomfort. Other findings include anxiety, tachycardia, tachypnea, a cough, pleuritic chest pain, hemoptysis, syncope, cyanosis, jugular vein distention, and hypotension.

Pulmonary tuberculosis

Vague dyspepsia may occur along with anorexia, malaise, and weight loss. Common associated findings include a high fever, night sweats, palpitations on mild exertion, a productive cough, dyspnea, adenopathy, and occasional hemoptysis.

Uremia

Of the many GI complaints associated with uremia, dyspepsia may be the earliest and most important. Others include anorexia, nausea, vomiting, bloating, diarrhea, abdominal cramps, epigastric pain, and weight gain. As the renal system deteriorates, the patient may experience edema, pruritus, pallor, hyperpigmentation, uremic frost, ecchymoses, sexual dysfunction, poor memory, irritability, a headache, drowsiness, muscle twitching, seizures, and oliguria.

Other causes

Drugs

Nonsteroidal anti-inflammatory drugs, especially aspirin, commonly cause dyspepsia. Diuretics, antibiotics, antihypertensives, corticosteroids, and many other drugs can cause dyspepsia, depending on the patient's tolerance of the dosage.

Surgery

After GI or other surgery, postoperative gastritis can cause dyspepsia, which usually disappears in a few weeks.

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Breast ulcer: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

❑ Breast cancer. A breast ulcer that doesn't heal within a month usually indicates cancer. Ulceration along a mastectomy scar may indicate metastatic cancer; a nodule beneath the ulcer may be a late sign of a fulminating tumor. Other signs include a palpable breast nodule, skin dimpling, nipple retraction, bloody or serous nipple discharge, erythema, peau d'orange, and enlarged axillary lymph nodes.

GENDER CUE:A breast ulcer may be the presenting sign of breast cancer in men, who are more apt to miss or dismiss earlier breast changes.

❑ Breast trauma. Tissue destruction with inadequate healing may produce breast ulcers. Associated signs depend on the type of trauma, but may include ecchymosis, lacerations, abrasions, swelling, and hematoma.

❑ Candida albicans infection. Severe Candida infection can cause maceration of breast tissue followed by ulceration. Well-defined, bright-red papular patches — usually with scaly borders — characterize the infection, which can develop in the breast folds. In breast-feeding women, cracked nipples predispose them to infection. Women describe the pain, felt when the infant sucks, as a burning pain that penetrates into the chest wall.

❑ Paget's disease. Bright-red nipple excoriation can extend to the areola and ulcerate. Serous or bloody nipple discharge and extreme nipple itching may accompany ulceration. Symptoms are usually unilateral.

Other causes

❑ Radiation therapy. After treatment, the breasts appear “sunburned.” Subsequently, the skin ulcerates and the surrounding area becomes red and tender.

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Corneal ulcers: Causes
(Professional Guide to Diseases (Eighth Edition))

Corneal ulcers generally result from protozoan, bacterial, viral, or fungal infections. Common bacterial sources include Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus viridans, Streptococcus (Diplococcus) pneumoniae, and Moraxella liquefaciens; viral sources comprise herpes simplex type 1, variola, vaccinia, and varicella-zoster viruses; and common fungal sources are Candida, Fusarium, and Cephalosporium.

Other causes include trauma, exposure, reactions to bacterial infections, toxins, trichiasis, entropion, allergens, and wearing of contact lenses. (See What happens in corneal ulceration.) Tuberculoprotein causes a classic phlyctenular keratoconjunctivitis, vitamin A deficiency results in xerophthalmia, and fifth cranial nerve lesions lead to neurotropic ulcers.

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Peptic ulcers: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Researchers recognize three major causes of peptic ulcer disease: infection with Helicobacter pylori (formerly known as Campylobacter pylori), use of NSAIDs, and pathologic hypersecretory disorders such as Zollinger-Ellison syndrome. (See How peptic ulcers develop.)

How H. pylori produces an ulcer isn’t clear. Gastric acid, which was considered a primary cause, now appears mainly to contribute to the consequences of infection. Ongoing studies should soon unveil the full mechanism of ulcer formation.

Salicylates and other NSAIDs encourage ulcer formation by inhibiting the secretion of prostaglandins (the substances that suppress ulceration). Certain illnesses, such as pancreatitis, hepatic disease, Crohn’s disease, preexisting gastritis, and Zollinger-Ellison syndrome, are also known causes.

Besides peptic ulcer’s main causes, several predisposing factors are acknowledged. They include blood type (gastric ulcers tend to strike people with type A blood; duodenal ulcers tend to afflict people with type O blood) and other genetic factors. Exposure to irritants, such as alcohol, coffee, and tobacco, may contribute by accelerating gastric acid emptying and promoting mucosal breakdown. Ulceration occurs when the acid secretion exceeds the buffering factors. Physical trauma, emotional stress, and normal aging are additional predisposing conditions.

In the United States, about 1.6 million people acquire peptic ulcers yearly. Males and females are affected equally, and incidence increases with age. A higher percentage of H. pylori infection occurs in people older than age 50.

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Pressure ulcers: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Most pressure ulcers are caused by pressure, particularly over bony prominences, that interrupts normal circulatory function, leading to ischemia of the underlying structures of skin, fat, and muscles. (See Pressure points: Common sites of pressure ulcers.) The intensity and duration of such pressure govern the severity of the ulcer; pressure exerted over an area for a moderate period (1 to 2 hours) produces tissue ischemia and increased capillary pressure, leading to edema and multiple small-vessel thromboses. An inflammatory reaction gives way to ulceration and necrosis of ischemic cells. In turn, necrotic tissue predisposes to bacterial invasion and subsequent infection.

The patient’s position determines the pressure exerted on the tissues. For example, if the head of the bed is elevated, or the patient assumes a slumped position, gravity pulls his weight downward and forward. This shearing force causes deep ulcers due to ischemic changes in the muscles and subcutaneous tissues, and occurs most often over the sacrum and ischial tuberosities.

Predisposing conditions for pressure ulcers include altered mobility, inadequate nutrition (leading to weight loss, subsequent reduction of subcutaneous tissue and muscle bulk and, possibly, a poorly functioning immune system), and a breakdown in skin or subcutaneous tissue (as a result of edema, incontinence, fever, pathologic conditions, or obesity).

Pressure ulcers occur in 10% to 17% of all hospitalized patients and 20% to 40% of all nursing home patients. Patients living at home aren’t free from risk, either: 20% of all pressure ulcers occur in the home. In the United States, there are approximately 2 million new cases of pressure ulcers diagnosed every year.

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Ulcerative colitis: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Although the etiology of ulcerative colitis is unknown, it’s thought to be related to abnormal immune response in the GI tract, possibly associated with food or bacteria such as Escherichia coli. Stress was once thought to be a cause of ulcerative colitis, but studies show that although it isn’t a cause, it does increase the severity of the attack.

Ulcerative colitis occurs primarily in young adults, especially in women. It’s also more prevalent among those of Jewish ancestry, indicating a possible familial tendency. The incidence of the disease is unknown; however, some studies indicate as many as 10 to 15 out of 100,000 persons have the disease. Onset of symptoms seems to peak between ages 15 and 30; another peak occurs between ages 50 and 70.

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Dyspepsia: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Cholelithiasis

Dyspepsia may occur with gallstones, commonly after intake of fatty foods. Biliary colic, a more common symptom of gallstones, causes acute pain that may radiate to the back, shoulders, and chest. The patient may also have diaphoresis, tachycardia, chills, low-grade fever, petechiae, bleeding tendencies, jaundice with pruritus, dark urine, and clay-colored stools.

Cirrhosis

In this chronic disorder, dyspepsia varies in intensity and duration and is relieved by ingestion of an antacid. Other GI effects are anorexia, nausea, vomiting, flatulence, diarrhea, constipation, abdominal distention, and epigastric or right-upper-quadrant pain. Weight loss, jaundice, hepatomegaly, ascites, dependent edema, fever, bleeding tendencies, and muscle weakness are also common. Skin changes include severe pruritus, extreme dryness, easy bruising, and lesions, such as telangiectasis and palmar erythema. Gynecomastia or testicular atrophy may also occur.

Duodenal ulcer

A primary symptom of duodenal ulcer, dyspepsia ranges from a vague feeling of fullness or pressure to a boring or aching sensation in the middle or right epigastrium. It usually occurs 1½ to 3 hours after eating and is relieved by food or an antacid. The pain may awaken the patient at night with heartburn and fluid regurgitation. Abdominal tenderness and weight gain may occur; vomiting and anorexia are rare.

Gastric dilation (acute)

Epigastric fullness is an early symptom of this life-threatening disorder. Accompanying dyspepsia are nausea and vomiting, upper abdominal distention, a succussion splash, and apathy. The patient may display signs and symptoms of dehydration, such as poor skin turgor and dry mucous membranes, and of electrolyte imbalance, such as irregular pulse and muscle weakness. Gastric bleeding may produce hematemesis and melena.

Gastric ulcer

Dyspepsia and heartburn after eating may occur in the early stages of a gastric ulcer. The cardinal symptom, however, is epigastric pain that may occur with vomiting, fullness, and abdominal distention and may not be relieved by food. Weight loss and GI bleeding are also characteristic.

Gastritis (chronic)

In this disorder, dyspepsia is relieved by antacids; lessened by smaller, more frequent meals; and aggravated by spicy foods or excessive caffeine. It occurs with anorexia, a feeling of fullness, vague epigastric pain, belching, nausea, and vomiting.

GI cancer

This type of cancer usually produces chronic dyspepsia. Other features include anorexia, fatigue, jaundice, melena, hematemesis, constipation, and abdominal pain.

Heart failure

Common in right-sided heart failure, transient dyspepsia may occur with chest tightness and a constant ache or sharp pain in the right upper quadrant. Heart failure also typically causes hepatomegaly, anorexia, nausea, vomiting, bloating, ascites, tachycardia, jugular vein distention, tachypnea, dyspnea, and orthopnea. Other findings include dependent edema, anxiety, fatigue, diaphoresis, hypotension, cough, crackles, ventricular and atrial gallops, nocturia, elevated diastolic blood pressure, and cool, pale skin.

Hepatitis

Dyspepsia occurs in two of the three stages of hepatitis. The preicteric phase produces moderate to severe dyspepsia, fever, malaise, arthralgia, coryza, myalgia, nausea, vomiting, an altered sense of taste or smell, and hepatomegaly. Jaundice marks the onset of the icteric phase, which also includes continued dyspepsia, anorexia, irritability, and severe pruritus. As jaundice clears, dyspepsia and other GI effects also diminish. In the recovery phase, only fatigue remains.

Hiatal hernia

In this disorder, dyspepsia results when the lower portion of the esophagus and the upper portion of the stomach rise into the chest as abdominal pressure increases.

Pancreatitis (chronic)

Dyspepsia is usually accompanied by severe continuous or intermittent epigastric pain that radiates to the back or through the abdomen. Anorexia, nausea, vomiting, jaundice, dramatic weight loss, hyperglycemia, and steatorrhea may also occur. The patient may have Turner’s or Cullen’s sign.

Pulmonary embolism

Sudden dyspnea characterizes this potentially fatal disorder; however, dyspepsia may occur as an oppressive, severe, substernal discomfort. Other findings include anxiety, tachycardia, tachypnea, cough, pleuritic chest pain, hemoptysis, syncope, cyanosis, jugular vein distention, and hypotension.

Pulmonary tuberculosis

Vague dyspepsia may occur along with anorexia, malaise, and weight loss. Common associated findings include high fever, night sweats, palpitations on mild exertion, a productive cough, dyspnea, adenopathy, and occasional hemoptysis.

Uremia

Of the many GI complaints associated with uremia, dyspepsia may be the earliest and most important. Others include anorexia, nausea, vomiting, bloating, diarrhea, abdominal cramps, epigastric pain, and weight gain. As the renal system deteriorates, the patient may experience edema, pruritus, pallor, hyperpigmentation, uremic frost, ecchymoses, sexual dysfunction, poor memory, irritability, headache, drowsiness, muscle twitching, seizures, and oliguria.

Other causes

Drugs

Nonsteroidal anti-inflammatory drugs, especially aspirin, commonly cause dyspepsia. Diuretics, antibiotics, antihypertensives, corticosteroids, and many other drugs can also cause dyspepsia, depending on the patient’s tolerance of the dosage.

Surgery

After GI or other surgery, postoperative gastritis can cause dyspepsia, which usually disappears in a few weeks.

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Breast ulcer: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Breast cancer

A breast ulcer that doesn’t heal within 1 month usually indicates cancer. Ulceration along a mastectomy scar may indicate metastatic cancer; a nodule beneath the ulcer may be a late sign of a fulminating tumor. Other signs include a palpable breast nodule, skin dimpling, nipple retraction, bloody or serous nipple discharge, erythema, peau d’orange, and enlarged axillary lymph nodes.

Breast trauma

Tissue destruction with inadequate healing may produce breast ulcers. Associated signs depend on the type of trauma but may include ecchymosis, lacerations, abrasions, swelling, and hematoma.

Candida albicans

A severe candidal infection can cause maceration of breast tissue followed by ulceration. Well-defined, bright-red papular patches—usually with scaly borders—characterize the infection, which can develop in the breast folds. Cracked nipples predispose breast-feeding women to this infection, which causes a burning pain that penetrates into the chest wall when the infant sucks.

Paget’s disease

Bright-red nipple excoriation can extend to the areola and ulcerate. A serous or bloody nipple discharge and extreme nipple itching may accompany ulceration. Symptoms are usually unilateral.

Other causes

Radiation therapy

After radiation, the breasts appear “sunburned.” Subsequently, the skin ulcerates and the surrounding area becomes red and tender.

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Genital Ulcer: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Herpes simplex

❑ Trauma

❑ Syphilis

❑ Fixed drug eruption

❑ Behçet syndrome

❑ Candida balanitis

❑ Granuloma inguinale

❑ Chancroid

❑ Lymphogranuloma venereum

❑ Bowen disease

❑ Carcinoma of the penis

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Leg Ulcer: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Venous insufficiency

❑ Arterial insufficiency

❑ Diabetes/neuropathy

❑ Decubitus ulcer

❑ Hypertension

❑ Squamous cell cancer

❑ Carbuncle

❑ Vasculitis

❑ Pyoderma gangrenosum

❑ Syphilis chancre

❑ Fistula

❑ Blood disorders

❑ Brown recluse spider bite

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Corneal ulcers: Causes
(Handbook of Diseases)

Corneal ulcers generally result from bacterial, protozoan, viral, or fungal infections. Common bacterial sources include Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus viridans, Streptococcus (Diplococcus) pneumoniae, and Moraxella liquefaciens; viral sources, herpes simplex type 1, and varicella-zoster viruses; and common fungi, such as Candida, Fusarium, and Cephalosporium.

Other causes include trauma, exposure, reactions to bacterial infections, toxins, and allergens. Tuberculoprotein causes a classic phlyctenular keratoconjunctivitis; vitamin A deficiency results in xerophthalmia; and fifth cranial nerve lesions result in neurotropic ulcers.

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Peptic ulcers: Causes
(Handbook of Diseases)

Researchers recognize three major causes of peptic ulcer disease: infection with Helicobacter pylori, use of nonsteroidal anti-inflammatory drugs (NSAIDs), and pathologic hypersecretory states such as Zollinger-Ellison syndrome.

H. pylori is the cause of the majority of duodenal and gastric ulcers. Following treatment with standard therapies, 70% to 85% of patients have a documented recurrence (by endoscopy) within 1 year.

Other causes include the use of certain drugs, such as salicylates and other NSAIDs, which encourage ulcer formation by inhibiting the secretion of prostaglandins (the substances that suppress ulceration). Certain illnesses —  such as pancreatitis, hepatic disease, Crohn’s disease, Zollinger-Ellison syndrome, and preexisting gastritis — are also known causes. Additionally, having a type A personality increases autonomic nervous system effects on the gastric mucosa.

Predisposing factors

Ulcers are more common in smokers and those who regularly use NSAIDs. (Smoking increases the amount ofhydrochloric acid in the stomach; nicotine reduces the bicarbonate content of pancreatic secretions and also decreases the degree of acid neutralization.) Diet and alcohol don’t appear to contribute to the development of peptic ulcer disease. It’s unclear whether emotional stress is a contributing factor.

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Pressure ulcers: Causes
(Handbook of Diseases)

Most pressure ulcers are caused by unrelieved pressure, particularly over bony prominences, that interrupts normal circulatory function, leading to ischemia of the underlying structures of skin, fat, and muscles. The intensity and duration of such pressure govern the severity of the ulcer; pressure exerted over an area for a moderate period (1 to 2 hours) produces tissue ischemia and increased capillary pressure, leading to edema and multiple small-vessel thromboses. An inflammatory reaction gives way to ulceration and necrosis of ischemic cells. In turn, necrotic tissue predisposes the patient to bacterial invasion and subsequent infection.

The patient’s position determines the pressure exerted on the tissues. For example, if the head of the bed is elevated or the patient assumes a slumped position, gravity pulls his weight downward and forward. This shearing force causes deep ulcers due to ische-mic changes in the muscles and subcutaneous tissues and most commonly affects the sacrum and ischial tuberosities.

Predisposing conditions for pressure ulcers include altered mobility, inadequate nutrition (leading to weight loss and subsequent reduction of subcutaneous tissue and muscle bulk), and a breakdown in skin or subcutaneous tissue (as a result of edema, incontinence, fever, pathologic conditions, or obesity).

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Ulcerative colitis: Causes
(Handbook of Diseases)

Although the etiology of ulcerative colitis is unknown, it’s thought to be related to an autoimmune response. Stress is no longer thought to be a cause. However, it may precipitate or increase the severity of the attack.

Ulcerative colitis occurs primarily in young adults, especially women; it’s also more prevalent among the Jewish population and individuals in higher socioeconomic groups. Onset of symptoms seems to peak in the 15- to 30-year-old age-group, with another peak occurring in the 50- to 70-year-old age-group.

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Dyspepsia: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Cholelithiasis

Dyspepsia may occur with cholelithiasis (the formation of gallstones), commonly after intake of fatty foods. Biliary colic, a more common symptom of cholelithiasis, causes acute pain that may radiate to the back, shoulders, and chest. The patient may also have diaphoresis, tachycardia, chills, low-grade fever, petechiae, bleeding tendencies, jaundice with pruritus, dark urine, and clay-colored stools.

Cirrhosis

With cirrhosis, dyspepsia varies in intensity and duration and is relieved by ingestion of an antacid. Other GI effects are anorexia, nausea, vomiting, flatulence, diarrhea, constipation, abdominal distention, and epigastric or right-upper-quadrant pain. Weight loss, jaundice, hepatomegaly, ascites, dependent edema, fever, bleeding tendencies, and muscle weakness are also common. Skin changes include severe pruritus, extreme dryness, easy bruising, and lesions, such as telangiectasis and palmar erythema. Gynecomastia or testicular atrophy may also occur.

Duodenal ulcer

A primary symptom of duodenal ulcer, dyspepsia ranges from a vague feeling of fullness or pressure to a boring or aching sensation in the middle or right epigastrium. It usually occurs 1½ to 3 hours after eating and is relieved by intake of food or ingestion of an antacid. The pain may awaken the patient at night with heartburn and fluid regurgitation. Abdominal tenderness and weight gain may occur; vomiting and anorexia are rare.

Gastric dilation (acute)

Epigastric fullness is an early symptom of acute gastric dilation, a life-threatening disorder. Accompanying dyspepsia are nausea and vomiting, upper abdominal distention, succussion splash, and apathy. The patient with acute gastric dilation may display signs and symptoms of dehydration, such as poor tissue turgor and dry mucous membranes, and of electrolyte imbalance, such as irregular pulse and muscle weakness. Gastric bleeding may produce hematemesis and melena.

Gastric ulcer

Typically, dyspepsia and heartburn after eating occur early in a gastric ulcer. The cardinal symptom, however, is epigastric pain that may occur with vomiting, fullness, and abdominal distention and may not be relieved by food. Weight loss and GI bleeding are also characteristic.

Gastritis (chronic)

With chronic gastritis, dyspepsia is relieved by antacids; lessened by smaller, more frequent meals; and aggravated by spicy foods or excessive caffeine. It occurs with anorexia, a feeling of fullness, vague epigastric pain, belching, nausea, and vomiting.

GI cancer

GI cancer usually produces chronic dyspepsia. Other features include anorexia, fatigue, jaundice, melena, hematemesis, constipation, and abdominal pain. The patient may also experience pain after eating that isn’t relieved by antacids. Syncope, weakness, and weight loss may also occur.

Heart failure

Common with right-sided heart failure, transient dyspepsia may occur with chest tightness and a constant ache or sharp pain in the right upper quadrant. Heart failure also typically causes hepatomegaly, anorexia, nausea, vomiting, bloating, ascites, tachycardia, jugular vein distention, tachypnea, dyspnea, and orthopnea. Other findings include dependent edema, anxiety, fatigue, diaphoresis, hypotension, cough, crackles, ventricular and atrial gallops, nocturia, diastolic hypertension, and cool, pale skin.

Hepatitis

Dyspepsia occurs in two of the three stages of hepatitis. The preicteric phase produces moderate to severe dyspepsia, fever, malaise, arthralgia, coryza, myalgia, nausea, vomiting, an altered sense of taste or smell, and hepatomegaly. Jaundice marks the onset of the icteric phase, along with continued dyspepsia and anorexia, irritability, and severe pruritus. As jaundice clears, dyspepsia and other GI effects also diminish. In the recovery phase, only fatigue remains.

Hiatal hernia

With hiatal hernia, dyspepsia results when increased abdominal pressure causes the lower portion of the esophagus and the upper portion of the stomach to rise into the chest. Other signs and symptoms include heartburn and retrosternal or substernal chest pain. Signs and symptoms of possible complications include dysphagia, bleeding, and severe pain and shock.

Pancreatitis (chronic)

With chronic pancreatitis, a feeling of fullness or dyspepsia is usually accompanied by severe continuous or intermittent epigastric pain that radiates to the back or through the abdomen. Anorexia, nausea, vomiting, jaundice, dramatic weight loss, hyperglycemia, and steatorrhea may also occur. The patient may have Turner’s or Cullen’s sign.

Uremia

Of the many GI complaints associated with uremia, dyspepsia may be the earliest and most important. Others include anorexia, nausea, vomiting, bloating, diarrhea, abdominal cramps, epigastric pain, and weight gain. As the renal system deteriorates, the patient may experience edema, pruritus, pallor, hyperpigmentation, uremic frost, ecchymoses, sexual dysfunction, poor memory, irritability, headache, drowsiness, muscle twitching, seizures, and oliguria.

Other causes

Drugs

Nonsteroidal anti-inflammatories, especially aspirin, commonly cause dyspepsia. Diuretics, antibiotics, antihypertensives, corticosteroids, and many other drugs can cause dyspepsia, depending on the patient’s tolerance of the dosage.

Surgery

After GI or other surgery, postoperative gastritis can cause dyspepsia, which usually disappears in a few weeks.

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Dyspepsia: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Cholelithiasis.Dyspepsia may occur with gallstones, usually after eating fatty foods. Biliary colic, a more common symptom of gallstones, causes acute pain that may radiate to the back, shoulders, and chest. The patient may also have diaphoresis, tachycardia, chills, a low-grade fever, petechiae, bleeding tendencies, jaundice with pruritus, dark urine, and clay-colored stools.

Cirrhosis.With cirrhosis, dyspepsia varies in intensity and duration and is relieved by taking an antacid. Other GI effects are anorexia, nausea, vomiting, flatulence, diarrhea, constipation, abdominal distention, and epigastric or right upper quadrant pain. Weight loss, jaundice, hepatomegaly, ascites, dependent edema, a fever, bleeding tendencies, and muscle weakness are also common. Skin changes include severe pruritus, extreme dryness, easy bruising, and lesions, such as telangiectasis and palmar erythema. Gynecomastia or testicular atrophy may also occur.

Duodenal ulcer.A primary symptom of a duodenal ulcer, dyspepsia ranges from a vague feeling of fullness or pressure to a boring or aching sensation in the middle or right epigastrium. It usually occurs 11⁄2 to 3 hours after a meal and is relieved by eating food or taking an antacid. The pain may awaken the patient at night with heartburn and fluid regurgitation. Abdominal tenderness and weight gain may occur; vomiting and anorexia are rare.

Gastric dilation (acute).Epigastric fullness is an early symptom of gastric dilation, a life-threatening disorder. Accompanying dyspepsia are nausea and vomiting, upper abdominal distention, succussion splash, and apathy. The patient may display signs and symptoms of dehydration, such as poor tissue turgor and dry mucous membranes, and of electrolyte imbalance, such as an irregular pulse and muscle weakness. Gastric bleeding may produce hematemesis and melena.

Gastric ulcer.Typically, dyspepsia and heartburn after eating occur early in gastric ulcer. The cardinal symptom, however, is epigastric pain that may occur with vomiting, fullness, and abdominal distention and may not be relieved by eating food. Weight loss and GI bleeding are also characteristic.

Gastritis (chronic).With chronic gastritis, dyspepsia is relieved by antacids; lessened by smaller, more frequent meals; and aggravated by spicy foods or excessive caffeine. It occurs with anorexia, a feeling of fullness, vague epigastric pain, belching, nausea, and vomiting.

GI cancer.GI cancer usually produces chronic dyspepsia. Other features include anorexia, fatigue, jaundice, melena, hematemesis, constipation, and abdominal pain.

Heart failure.Common with right-sided heart failure, transient dyspepsia may occur with chest tightness and a constant ache or sharp pain in the right upper quadrant. Heart failure also typically causes hepatomegaly, anorexia, nausea, vomiting, bloating, ascites, tachycardia, jugular vein distention, tachypnea, dyspnea, and orthopnea. Other findings include dependent edema, anxiety, fatigue, diaphoresis, hypotension, a cough, crackles, ventricular and atrial gallops, nocturia, diastolic hypertension, and cool, pale skin.

Hepatitis.Dyspepsia occurs in two of the three stages of hepatitis. The preicteric phase produces moderate to severe dyspepsia, a fever, malaise, arthralgia, coryza, myalgia, nausea, vomiting, an altered sense of taste or smell, and hepatomegaly. Jaundice marks the onset of the icteric phase, along with continued dyspepsia and anorexia, irritability, and severe pruritus. As jaundice clears, dyspepsia and other GI effects also diminish. In the recovery phase, only fatigue remains.

Hiatal hernia.Dyspepsia is a result of the lower portion of the esophagus and the upper portion of the stomach rising into the chest when abdominal pressure increases.

Pulmonary embolism.Sudden dyspnea characterizes pulmonary embolism, a potentially fatal disorder; however, dyspepsia may occur as an oppressive, severe, substernal discomfort. Other findings include anxiety, tachycardia, tachypnea, a cough, pleuritic chest pain, hemoptysis, syncope, cyanosis, jugular vein distention, and hypotension.

Pulmonary tuberculosis.Vague dyspepsia may occur along with anorexia, malaise, and weight loss. Common associated findings include a high fever, night sweats, palpitations on mild exertion, a productive cough, dyspnea, adenopathy, and occasional hemoptysis.

Uremia.Of the many GI complaints associated with uremia, dyspepsia may be the earliest and most important. Others include anorexia, nausea, vomiting, bloating, diarrhea, abdominal cramps, epigastric pain, and weight gain. As the renal system deteriorates, the patient may experience edema, pruritus, pallor, hyperpigmentation, uremic frost, ecchymoses, sexual dysfunction, poor memory, irritability, headache, drowsiness, muscle twitching, seizures, and oliguria.

Other causes

Drugs.Nonsteroidal anti-inflammatory drugs, especially aspirin, commonly cause dyspepsia. Diuretics, antibiotics, antihypertensives, corticosteroids, and many other drugs can cause dyspepsia, depending on the patient's tolerance of the dosage.

Surgery.After GI or other surgery, postoperative gastritis can cause dyspepsia, which usually disappears in a few weeks.

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Breast ulcer: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Breast cancer.A breast ulcer that doesn't heal within a month usually indicates breast cancer. Ulceration along a mastectomy scar may indicate metastatic cancer; a nodule beneath the ulcer may be a late sign of a fulminating tumor. Other signs include a palpable breast nodule, skin dimpling, nipple retraction, bloody or serous nipple discharge, erythema, peau d'orange, and enlarged axillary lymph nodes.

Breast trauma.Tissue destruction from breast trauma with inadequate healing may produce breast ulcers. Associated signs depend on the type of trauma, but may include ecchymosis, lacerations, abrasions, swelling, and hematoma.

Candida albicans infection. Severe Candida infection can cause maceration of breast tissue followed by ulceration. Well-defined, bright-red papular patches—usually with scaly borders—characterize the infection, which can develop in the breast folds. In breast-feeding women, cracked nipples predispose them to infection. Women describe the pain, felt when the infant sucks, as a burning pain that penetrates into the chest wall.

Paget's disease.Bright-red nipple excoriation can extend to the areola and ulcerate. Serous or bloody nipple discharge and extreme nipple itching may accompany ulceration. Symptoms are usually unilateral.

Other causes

Radiation therapy.After treatment, the breasts appear “sunburned.” Subsequently, the skin ulcerates and the surrounding area becomes red and tender.

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Ulcer as a complication of other conditions:

Other conditions that might have Ulcer as a complication may, potentially, be an underlying cause of Ulcer. Our database lists the following as having Ulcer as a complication of that condition:

• Klippel Trenaunay Weber syndrome
• Lipodermatosclerosis

Ulcer as a symptom:

Conditions listing Ulcer as a symptom may also be potential underlying causes of Ulcer. Our database lists the following as having Ulcer as a symptom of that condition:

• Cutaneous necrotizing vasculitis
• Dermatomyositis
• Granuloma inguinale
• Palate cancer
• Pemphigus
• Pyoderma Gangrenosum

Medications or substances causing Ulcer:

The following drugs, medications, substances or toxins are some of the possible causes of Ulcer as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

• Clusiol
• Saldac
• Hydroxyurea
• Hydrea
• Vesanoid

See full list of 11 medications causing Ulcer

Medical news summaries relating to Ulcer:

The following medical news items are relevant to causes of Ulcer:

• Chemical signals involved in cancer causes found
• Colon cancer prevented with aspirin
• Diet changes can benefit skin ulcer sufferers
• Smoking also linked to stomach cancer
• Vioxx tended not to be used by targeted group

Related information on causes of Ulcer:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Ulcer may be found in:

• Risk factors for Ulcer
• Medications that may cause Ulcer
• Hidden causes of Ulcer

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