Curling's ulcer

Curling's ulcer is a type of peptic ulcer that develops in patients with severe burns, trauma, or critical illnesses. It was first described by the British doctor Thomas Blizard Curling in 1842.

Etiology

Curling's ulcer is caused by reduced mucosal blood flow and increased gastric acid secretion, which are common in patients with severe burns or trauma. The exact mechanism is not fully understood, but it is believed to involve a combination of ischemia, reperfusion injury, and oxidative stress.

Clinical Features

Patients with Curling's ulcer may present with abdominal pain, nausea, vomiting, and melena (black, tarry stools). In severe cases, the ulcer can perforate, leading to peritonitis and septic shock.

Diagnosis

The diagnosis of Curling's ulcer is usually made by endoscopy, which allows direct visualization of the ulcer. Other diagnostic tests may include a complete blood count (CBC), liver function tests, and a stool test for occult blood.

Treatment

The treatment of Curling's ulcer involves acid suppression with proton pump inhibitors (PPIs) or H2 receptor antagonists, and cytoprotective agents such as sucralfate. In severe cases, surgery may be required to repair a perforated ulcer.

Prevention

Prevention of Curling's ulcer in critically ill patients involves early enteral nutrition, stress ulcer prophylaxis with PPIs or H2 receptor antagonists, and careful monitoring for signs of gastrointestinal bleeding.

See Also

• Peptic ulcer
• Stress ulcer
• Cushing's ulcer

References

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