Patients with duodenal ulcer have a variety of clinical presentations, ranging from individuals who are completely asymptomatic to those who develop severe complications, such as GI hemorrhage.
Some generalizations can be made with respect to common clinical presentations of duodenal ulcer.
Some common symptoms in patients with duodenal ulcer are described below.
Epigastric pain can be sharp, dull, burning, or penetrating.
Many patients experience a feeling of hunger.
The pain may radiate into the back.
About 20-40% of patients describe bloating, belching, or symptoms suggestive of gastroesophageal reflux.
Ulcer-related pain generally occurs 2-3 hours after meals and often awakens the patient at night. This pattern is believed to be the result of increased gastric acid secretion, which occurs after meals and during the late night and early morning hours when circadian stimulation of gastric acid secretion is the highest.
About 50-80% of patients with duodenal ulcer experience nightly pain, as opposed to only 30-40% of patients with gastric ulcer and 20-40% of patients with nonulcer dyspepsia (NUD).
Pain is often relieved by food, a finding often cited as being specific for duodenal ulcer. However, this symptom is present in only 20-60% of patients and probably not specific for duodenal ulcer.
The pain of duodenal ulcer is generally episodic; however, the pain can evolve into a chronic, daily occurrence in some patients.
A change in the patient's usual pattern of ulcer pain should be considered serious because it may herald an imminent complication. When food or antacids fail to relieve the pain or when the pain begins to radiate to new anatomical locations, a high index of suspicion is warranted.
Concern is especially warranted in the setting of new-onset nausea and vomiting, decreased appetite, and weight loss.
GI bleeding is a common complication of duodenal ulcer and can have serious consequences.
Patients may present with melena, coffee-ground emesis, or hematemesis.
The passage of frank blood in the stool or maroon-colored stool in the presence of a bleeding duodenal ulcer suggests precipitous GI bleeding.
He is still in the hospital (private room, no less) being monitored. It sounds as if he is getting a LOT of attention from a LOT of smart people. He hasn't eaten in three full days.
Was doing to weedwacking and decided to take the dogs for a walk. We went over the bridge and turned right into the field and at the end it looked like a trail of sorts so we followed it and made many wrong turns and got lost. We crossed the creek a couple of times (wet dogs and wet feet). It started sprinkling. Finally, we found the water road and were walking down it when the guy that lives on the property came down the road. I told him I was lost and he gave me a lift home. We wandered the woods for about an hour or more. I think unless someone is with me, I will stick to the pastures. I did have my cell phone but that was my last recourse because I was too embarrassed to call and say I was in the middle of the woods SOMEWHERE. So after my feet warm up I am going back outside and weed wack.
The water guy said last night a girl was lost at the reservoir and the Sheriff's Department was up looking for her. Since they didn't have the code to open the water road gates, they took them off the hinges. He said they did find her
Sid called Mother this morning from the hospital and he is up and functioning in a close-to-normal way! They fixed the bleeding ulcer in his little intestine last night (they think) but will monitor him in the hospital for a day or two to make sure the bleeding is stopped.
We are so lucky to have had Sandra on the scene, keeping the doctors on task and keeping us informed. Thank you, Sandra! You are a blessing to this family.
I am so happy to have my brother back on the mend. I was ready to fly to Philly and would have been a monumental pest, I am sure.
My, what a week! Sid in a hospital, Judi enroute to California and Texas, Kay and two dogs keeping things normal at the farm, a new dishwasher to arrive tomorrow (a mechanical one), KC on tdy at Washington D.C. for the current week and then meeting with Tom
and Tory and certain Borzoi at the races in Oklahoma and for myself I need to make room for the dishwasher by removing many items stored on the drainboard (I'm getting a new countertop also) with Kay's help and mentally planning for the changes in the kitchen.
I am challenged by the changes, the computer which jumps around, and thankful for the communication regarding Sid. I'm going to end this before it disappears.
I had a major adrenaline rush this morning while reading an appellate brief written in a case where opposing counsel (2 of them) are frankly incompetent (at least they have been on this case). In the brief, they make a COMPLETELY unsupported allegation against my client and it makes me want to SCREAM!!!! Now the adrenaline rush has subsided and I want to go to sleep.
I shaved a couple of minutes off my 5K record in the race I ran last Sunday. Of course the hills were smaller on this course, but so what. Also the photo of me running across the finish line was slightly more flattering. I'm taking baby steps, but progress is progress.
All is well here. We all have jobs and the grass is growing and things are blooming. We may actually get around to planting some veggies this weekend.
I'll be in Corvallis for Mother's Day. I talked to Kay last night and she said there was nothing in her working life that she missed. She sounded very happy.
We have our new computer installed and it appears to be working well. Jessica helped by getting our photos off the old computer and onto an external drive where they will be stored. Whew!
I went to an all day CLE (continuing legal education) class yesterday. It was on school law and it was very, very interesting. Schools are becoming increasingly complex entities. Not so good for the education of our students, even when the complexities are intended to improve education. We need our schools to have well-educated and well-paid teachers and administrators who are given maximum flexibility to deliver services to the needs of their student populations. So see? I solved the problems. That was easy - now I'm off to solve another national crisis.
It is rainy today. Darn! Now our gardening will be put on hold for yet another weekend.
Well, it's Thursday, and it has been pretty unexciting except that our home computer (purchased in 2002) appears to have committed suicide, so we may have to get a new one.
Cree hired to replace Pepple as MIHS basketball coach
By MATT PHELPS
Mercer Island Reporter Sports Editor
Apr 20 2009, 6:12 PM · UPDATED
Gavin Cree has more experience than most with the Mercer Island High School basketball program. He also knows how revered his former mentor Ed Pepple is and what the expectations are for the program. He will now get his chance step onto the MIHS basketball sideline as head coach. Mercer Island High School assistant principal Craig Olson announced the decision to hire Cree Monday afternoon.
"Taking over for a legend is not an easy task, but he has the ability and capability to do it," said Olson.
Cree is a 2000 graduate of Mercer Island High School and played for Ed Pepple, the man he will replace.
“I am truly honored to be in a position to carry on the Islander basketball tradition developed over so many years by Coach Pepple,†said Cree in an email. “I am confident that under my guidance, players will continue to share in this special camaraderie. I am eager lead a basketball program that our school and community can continue to be proud of.â€Â
Cree has been an assistant with the team for five years, grew up on the Island and played basketball at Pomona College in Claremont, Calif. Cree has a Bachelors of Arts in psychology from Pomona and is currently working toward an educational endorsement from Seattle Pacific University for fitness.
"I have been working with him since he was 11, and I have watched him turn into an outstanding young man and coach," said Pepple.
Olson is confident that Cree is the right person for the job, although he was the only person interviewed for the position and has no head coaching experience at the high school level.
"He has learned from the absolute best," said Olson. "He played in Little Dribblers and grew up on the Island. He knows the expectations."
And those expectations will be huge as he replaces the all-time winningest coach in Washington state history. Pepple coached at Mercer Island High School for nearly five decades, winning 952 games during his career, along with four state titles. Pepple never had a team under .500 in-league play at Mercer Island High School.
"He had Ed's full confidence and a big recommendation," said Olson, who  along with MIHS Principal John Harrison  made the decision.
Olson also addressed Pepple's future role with the program.
"He can have as much or as little as he wants to do with it," said Olson.
For Pepple's part, he said that he will be Mercer Island's No. 1 supporter and that it is Cree's team now.
Mercer Island Reporter Sports Editor Matt Phelps can be reached at mphelps@mi-reporter.com or (206) 232-1215.
