Peptic Ulcer — Clinical

A 48-year-old woman on chronic NSAIDs for osteoarthritis presents with a 6-week history of epigastric pain, early satiety, and weight loss of 2 kg. Upper endoscopy reveals a 3 cm ulcer in the antrum with clean base and no active bleeding. H. pylori serology is negative. What is the most appropriate next step in management?

A 52-year-old man with a 10-year history of epigastric pain presents with acute severe pain, vomiting, and signs of peritonitis. Imaging confirms perforation. A 38-year-old woman with similar chronic epigastric symptoms presents with melena and hemodynamic stability; endoscopy shows a bleeding ulcer. Which single feature best distinguishes a perforated peptic ulcer from a bleeding peptic ulcer?

A 48-year-old woman with H. pylori–positive duodenal ulcer disease presents for eradication therapy. She has no drug allergies and normal renal function. What is the preferred first-line regimen for H. pylori eradication in India?

A 52-year-old man from Delhi presents with a 3-month history of epigastric pain that wakes him at night. He takes aspirin 500 mg daily for chronic headaches. On examination, he is afebrile with mild epigastric tenderness. Hemoglobin is 10.2 g/dL. Upper GI endoscopy reveals a 1.5 cm ulcer on the anterior wall of the first part of the duodenum with a visible vessel at the base. H. pylori serology is negative and urine pH is normal. What is the most likely diagnosis?

A 38-year-old woman from Mumbai presents with a 2-week history of severe epigastric pain, vomiting, and hematemesis. She denies NSAID use and H. pylori testing is negative. On examination, she is hemodynamically stable (BP 118/76, HR 88). Endoscopy shows a large, deep ulcer on the posterior wall of the first part of the duodenum with a visible artery. Laboratory studies reveal serum gastrin 850 pg/mL (normal <100), gastric pH 1.2, and normal serum calcium. What is the most likely diagnosis?