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Gastroenterology Gastric Pathology Beginner
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Stress Gastric Ulcers: Curling vs Cushing

CURLING
vs
CUSHING
Classic board differentiation between the two physiological stress-induced acute peptic ulcers.

Severe physiological trauma predisposes patients to severe erosive gastritis or ulceration via two distinct pathophysiological mechanisms depending on the primary insult.

Systematic Breakdown

Curling

Burn Ulcers

Curling = burn like a curling iron. Severe extensive burns lead to hypovolemia and mucosal ischemia, stripping away protective mucous barrier.

Cushing

CNS / ICP Ulcers

Cushing = Brain Cushion. Increased intracranial pressure or brain injury directly stimulates vagal nuclei, causing hypersecretion of gastric acid (HCl).

High-Yield Clinical Pearls & Exam Tips
  • Curling ulcers: Ischemia-driven (decreased mucosal perfusion), primarily in proximal duodenum.
  • Cushing ulcers: Acid hypersecretion-driven (vagal acetylcholine hyperactivation), higher risk of perforation.
  • Both warrant stress ulcer prophylaxis with PPIs or H2 blockers in ICU settings.
Related Pharmaceuticals
Omeprazole Pantoprazole Famotidine
Related Clinical Conditions
Thermal Burns Traumatic Brain Injury Intracranial Hemorrhage
Authoritative Sources: Robbins & Cotran Pathologic Basis of Disease 10e · First Aid USMLE Step 1

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The classic, highest-yield mnemonic for recalling causes of acute pancreatitis, with gallstones and alcohol accounting for ~70% of presentations.

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Acute Cholangitis: Charcot Triad & Reynolds Pentad

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Clinical indicators of acute bacterial ascending cholangitis, differentiating uncomplicated cholangitis from septic biliary emergency.

Tokyo Guidelines (TG18/TG13) for Acute Cholangitis 1,244

System Notice

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