| Cushing ulcer | |
|---|---|
| Specialty | General surgery |
ACushing ulcer, named afterHarvey Cushing,[1][2] is agastric ulcer associated with elevatedintracranial pressure. It is also called vonRokitansky–Cushing syndrome.[2] Apart from thestomach, ulcers may also develop in the proximalduodenum and distalesophagus.
The mechanism of development of Cushing ulcers is thought to be due to direct stimulation of vagal nuclei as a result of increasedintracranial pressure. Brain tumors, traumatic head injury, and other intracranial processes including infections, can cause increased intracranial pressure and lead to overstimulation of the vagus nerve.[3]Efferent fibers of thevagus nerve then releaseacetylcholine onto gastricparietal cellM3 receptors, causing insertion ofhydrogen potassium ATPase vesicles into the apical plasma membrane. The end result is increased secretion ofgastric acid with eventual ulceration of the gastric mucosa.
As Cushing ulcers have a higher incidence of developing after shock,sepsis or trauma, diagnosis should include recent medical history evaluation. Bothendoscopy andangiography can be used to locate thelesion orulcer, though endoscopy is more commonly used as a first-line diagnosis procedure.[4]
Most episodes of Cushing ulceration resolve on medical intervention, consisting primarily of rinsing the area withsaline and the administration ofantacids.[5]