# Situation: A 38-year-old man comes to the outpatient clinic with epigastric pain for the past 2 months. He takes no regular medicines and has no known drug allergies. He describes a gnawing pain that comes about 2 to 3 hours after meals, often wakes him at around 01:00, and eases when he eats crackers. He has gained 2 kg over these 2 months. Which condition do these findings MOST suggest?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630273  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 38-year-old man comes to the outpatient clinic with epigastric pain for the past 2 months. He takes no regular medicines and has no known drug allergies.

He describes a gnawing pain that comes about 2 to 3 hours after meals, often wakes him at around 01:00, and eases when he eats crackers. He has gained 2 kg over these 2 months. Which condition do these findings MOST suggest?

## 보기

1. Duodenal ulcer **✔ 정답**
2. Gastroesophageal reflux disease
3. Gastric ulcer
4. Acute gastritis

**정답: 1**

## 해설

Duodenal ulcer pain typically appears 2 to 3 hours after meals and at night, when acid is secreted with no food to buffer it, and it is relieved by eating; weight is maintained or gained. Gastric ulcer pain comes soon after eating and often leads to weight loss from fear of eating.

## 심화 해설

The findings point to a duodenal ulcer
The client has gnawing epigastric pain 2 to 3 hours after meals, pain that wakes him at around 01:00, relief when he eats crackers, and a 2-kg weight gain. This is the classic picture of a duodenal ulcer. Pain that comes when the stomach is empty and is relieved by food, with weight maintained or gained, distinguishes a duodenal ulcer from a gastric ulcer.

Why the timing fits
Duodenal ulcers are associated with high acid secretion. After a meal, food buffers gastric acid. Two to three hours later, the stomach empties while acid continues to be secreted and reaches the duodenum unbuffered, irritating the ulcer. At night, acid secretion continues with no food present, which explains the pain that wakes him in the early morning hours. Eating buffers the acid again and relieves the pain, so many clients eat more often and gain weight.

| Feature | Duodenal ulcer | Gastric ulcer |
| --- | --- | --- |
| Pain timing | 2 to 3 hours after meals; at night | Soon after eating |
| Effect of food | Relieves pain | Worsens pain |
| Weight | Maintained or gained | Often lost from fear of eating |
| Acid secretion | Normal to high | Normal to low |
| Nighttime pain | Common | Less common |

Why the other conditions are less likely
Gastroesophageal reflux disease causes heartburn and regurgitation after meals and when lying down, not gnawing pain relieved by eating. Gastric ulcer pain comes soon after meals and is worsened by food, often causing weight loss. Acute gastritis causes epigastric pain with nausea and vomiting, often after nonsteroidal anti-inflammatory drugs (NSAIDs) or alcohol, without this timed pattern of relief by food. Watch out! The symptom pattern suggests a diagnosis, but confirmation is by endoscopy, and testing for Helicobacter pylori is part of the workup because it is the leading cause of duodenal ulcers.

Nursing priorities
The nurse asks about NSAID use, smoking, and alcohol, and teaches warning signs of complications: black or tarry stools, vomiting of blood or coffee-ground material, sudden severe abdominal pain (possible perforation), and persistent vomiting (possible obstruction). Clients are advised to avoid NSAIDs and smoking, which delays healing, and to take prescribed acid-suppressing drugs and H. pylori therapy as directed.

Exam takeaway
Key point! Duodenal ulcer: pain 2 to 3 hours after meals and at night, relieved by food, weight gain. Gastric ulcer: pain soon after meals, worsened by food, weight loss. Remember: duodenal pain is decreased by eating; gastric pain is greater with eating.

## 임상 시나리오

Duodenal vs Gastric UlcerReading the timing of epigastric pain
Duodenal ulcer: gnawing pain 2 to 3 hours after meals and at night, relieved by food; weight is maintained or gained.

Gastric ulcer: pain soon after eating, worsened by food, often with weight loss from fear of eating.

Confirm with endoscopy, test for Helicobacter pylori, and ask about NSAIDs, smoking, and alcohol.

CautionTeach warning signs: black or tarry stools, vomiting blood or coffee-ground material, sudden severe abdominal pain, and persistent vomiting.

## 핵심 개념

- **Duodenal ulcer** — A peptic ulcer in the duodenum, with pain on an empty stomach that is relieved by food.
- **Gastric ulcer** — A peptic ulcer in the stomach, with pain soon after eating that is worsened by food.
- **Helicobacter pylori** — A gram-negative bacterium that colonizes the stomach and is a leading cause of peptic ulcers.
- **Gastroesophageal reflux disease** — Backflow of gastric contents into the esophagus causing heartburn and regurgitation.
- **Epigastric pain** — Pain in the upper central abdomen, below the sternum.

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