Stress Ulcer

Stress ulcer refers to an ulcer or, more often, multiple ulcers that develop during the severe physiologic stress of serious illness.

I. The pathogenesis

of stress ulcer is unclear but probably is related to a reduction in mucosal blood flow or a breakdown in other normal mucosal defense mechanisms (see Chapter 24) in conjunction with the injurious effects of acid and pepsin on the gastroduodenal mucosa.

A. The ulcerations

may be superficial and confined to the mucosa, in which case they are more appropriately called erosions, or they may penetrate deeper into the submucosa. The former may cause diffuse mucosal oozing of blood, whereas the latter may erode into a submucosal vessel and produce frank hemorrhage.

B. Location.

Stress ulcerations may develop anywhere within the stomach and proximal duodenum but are more likely to occur in fundic mucosa, which lines the body and fundus of the stomach. This is in contradistinction to the location of ordinary peptic ulcers, which typically are found in the gastric antrum and the duodenum.

C. The clinical setting

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