Stress induced ulcers are most commonly found in?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Explanation

Stress-induced ulcers, or Stress-Related Mucosal Disease (SRMD), are acute erosions that develop in critically ill patients.
The primary cause is reduced blood flow (ischemia) to the stomach lining due to severe physiological stress like shock, sepsis, or major trauma.
This ischemia weakens the mucosal defense, making it vulnerable to damage from the stomach's own acid.
The fundus and body of the stomach are the main acid-producing regions, and therefore are the most common sites for these lesions.

Option A: The stomach antrum is a common location for chronic peptic ulcers, which are typically caused by H. pylori infection or long-term NSAID use, not acute physiological stress.
Option C: While ulcers can occur in the pyloric channel, it is a less common site overall and is typically associated with chronic peptic ulcer disease rather than acute stress ulcers.
Option D: The first part of the duodenum is the most common site for chronic peptic ulcers in general. It is also the location for a specific type of stress ulcer, the Curling's ulcer, which is associated with severe burns, not all causes of physiological stress.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology and location of stress-induced gastric ulcers as background academic context rather than a clinical decision trigger.
Nurses in critical care settings must be vigilant for signs of upper GI bleeding (hematemesis, melena) in high-risk patients, as this is the main complication of stress ulcers.
Stress Ulcer Prophylaxis (SUP) with medications like Proton Pump Inhibitors (PPIs) or H2-receptor antagonists is a standard intervention for ventilated patients or those with coagulopathy to prevent SRMD.
What if? If the patient had a severe head injury (intracranial disease), the ulcer could be a Cushing's ulcer. These can occur in the stomach, duodenum, or esophagus and are caused by acid hypersecretion due to vagal stimulation, carrying a high risk of perforation.

How to Approach the Question

First, identify the key term in the question: 'Stress induced ulcers'.
Differentiate this specific type of acute ulcer from chronic peptic ulcers, which have different causes and locations.
Recall the pathophysiology of stress ulcers: they are caused by ischemia (reduced blood flow) in the context of critical illness, making the mucosa vulnerable to acid.
Relate the pathophysiology to anatomy: The most acid is produced in the fundus and body of the stomach.
Conclude that the most vulnerable and common location for this type of injury is the stomach fundus/body.
Eliminate other options: The antrum and duodenum are classic sites for chronic peptic ulcers (H. pylori, NSAIDs), not general stress ulcers.

Concept Tested & Keywords

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 767-769

E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 3 (515-969) p. 33-35

E6 PATHOLOGY QUICK REVIEWBased on Harsh Mohan Textbook of PATHOLOGY p. 142-144

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