37. Bleeding ulcer.

Question 1

Bleeding ulcer - Definition

Answer 1

Complication of peptic ulcer that is an acute or chronic lesion

Question 2

Bleeding ulcer - Types

Answer 2

Acute ulcers:
- Cause severe bleeding – difficult to dx – develop rapidly + heal w/o scar within a few weeks
- May only be dx if endoscopy done within 1-2 days of bleeding
o Small, discrete lesion with hyperemic margin + sometimes large vessel exposed at base of ulcer
- Gastric lesions occur with low rate of acid
- Duodenal lesions occur with high rate of acid

Chronic ulcers:

• Increased tendency of haemorrhage if pt is of blood O group
• Initial haemorrhage is not fatal – becomes fatal when recurrent haemorrhage occurs or sudden severe haemorrhage
• Bleeding may not stop so easily by natural hemostasis

Question 3

Bleeding ulcer – Clinical Presentation

Answer 3

Malaise

Lightheadedness

Sweating

Pallor when haemorrhage occurs

• Ab pain, black tarry stools (melena) + hematemesis
• In case of DU – melena is present
• In case of GU – hematemesis occurs 1st then melena

Low BP

Increased HR

Increased breathing

Anaemia

Jaundice

Question 4

Bleeding ulcer - - Complication

Answer 4

Bleeding ulcer can result in significant blood loss thus require hospitalization

• Blood loss can lead to shock

Question 5

Bleeding ulcer - Conservative Treatment

Answer 5

PPI (proton pump inhibitor), Tranex amic acid = inhibitor of fibrolysis – reduces bleeding rate

• IV infusion of blood.

Nasogastric tube introduced.

Bleeding tx with diathermy

heater probes + lasers

Question 6

Bleeding ulcer - Surgical Treatment

Answer 6

Done if there is continuous bleeding

o Common source of bleeding comes from gastroduodenal artery

o Duodenum opened so bleeding can be seen + surgeons hand can be placed behind gastroduodenal artery
 Opened longitudinally = suture bleeding point through transverse pyloroduodenal