NORCET 5 Prelims - Se…: Which of the following statement is NOT TRUE regarding peptic ulcer and duodenal ulcer? & x20;

NORCET 5 Prelims - Sept 2023 (Shift-1)

Medical & Surgical Nursing

Medium

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-1)

Explanation

The statement that anterior wall duodenal ulcers are more prone to bleeding than perforation is incorrect.
Anterior duodenal ulcers are anatomically positioned to perforate into the free peritoneal cavity, causing acute chemical peritonitis, a surgical emergency.
Conversely, posterior duodenal ulcers are more likely to cause major bleeding (hemorrhage) because they can erode into the gastroduodenal artery, which is located directly behind the first part of the duodenum.

Option A: This statement is true. While the risk is low (less than 1%), chronic gastric ulcers have the potential for malignant transformation into gastric adenocarcinoma. Duodenal ulcers are considered benign.
Option B: This statement is true. Epidemiologically, duodenal ulcers are significantly more common than gastric ulcers, with a reported ratio of approximately 4:1.
Option C: This statement is true. A Type II gastric ulcer (Modified Johnson classification) is a gastric ulcer that occurs in combination with a duodenal ulcer. This condition is associated with gastric acid hypersecretion, which is the primary pathogenic factor for the duodenal ulcer component.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Differential characteristics and complications of gastric and duodenal ulcers as background academic context rather than a clinical decision trigger.
Nurses must be vigilant in assessing patients with peptic ulcer disease for signs of life-threatening complications. A sudden, severe, board-like abdomen suggests perforation (common with anterior ulcers), while signs of shock (hypotension, tachycardia), hematemesis, or melena suggest hemorrhage (common with posterior ulcers).
What if? If the patient had a posterior duodenal ulcer, the primary nursing concern would shift from peritonitis to hypovolemic shock due to hemorrhage. Immediate interventions would include establishing large-bore IV access for fluid and blood product resuscitation and preparing for an emergency endoscopy.

How to Approach the Question

This is a 'negative' question, asking for the false statement. The best approach is to evaluate each option independently for its factual accuracy.
Step 1: Analyze Option A. Recall the relationship between ulcer type and cancer risk. Gastric ulcers can be malignant; duodenal ulcers are not. This statement is true.
Step 2: Analyze Option B. Recall the relative incidence of gastric versus duodenal ulcers. Duodenal ulcers are more common. This statement is true.
Step 3: Analyze Option C. Recall the classification of gastric ulcers. Type II ulcers are associated with duodenal ulcers and, therefore, high acid secretion. This statement is true.
Step 4: Analyze Option D. Recall the anatomy of the duodenum and its common complications. Anterior ulcers face the open abdomen and perforate. Posterior ulcers are near the gastroduodenal artery and bleed. This statement claims the opposite, so it is false.
Step 5: Conclude that the false statement (Option D) is the correct answer to the 'NOT TRUE' question.

Concept Tested & Keywords

Concept Tested: Differential characteristics and complications of gastric and duodenal ulcers.
Stem keywords: peptic ulcer, duodenal ulcer, gastric ulcer, malignancies, secretion of HCl, bleeding, perforation
Lead-in keywords: NOT TRUE
Negative lead-in flag: Question asks for the INCORRECT statement.

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