Chapter 39: UGI Bleed- DU Flashcards

1
Q

In which age group are these ulcers most common?

A

40 to 65 years of age (younger than patients with gastric ulcer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the ratio of male to female patients?

A

Men > women (3:1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common location?

A

Most are within 2 cm of the pylorus in the duodenal bulb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the classic pain response to food intake?

A

Food classically relieves duodenal ulcer pain

(Think: Duodenum = Decreased with food)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the cause?

A

Increased production of gastric acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What syndrome must you always think of with a duodenal ulcer?

A

Zollinger–Ellison syndrome (ZES)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the major symptoms?

A
  1. Epigastric pain
  2. Bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs?

A
  1. Tenderness in epigastric area (possibly)
  2. guaiac-positive stool
  3. melena
  4. hematochezia
  5. hematemesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the differential diagnosis?

A
  1. Acute abdomen
  2. pancreatitis
  3. cholecystitis
  4. all causes of UGI bleeding
  5. ZES
  6. gastritis
  7. MI
  8. gastric ulcer reflux
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is the diagnosis made?

A
  1. History
  2. PE
  3. EGD
  4. UGI series (if patient is not actively bleeding)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is surgery indicated with a bleeding duodenal ulcer?

A

Most surgeons use: (OR)

  1. >6 unit PRBC transfusions
  2. >3 unit PRBCs needed to stabilize
  3. for significant rebleed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the medical treatment?

A
  1. Proton-pump inhibitors (PPIs) or H2 receptor antagonists—heals ulcers in 4 to 6 weeks in most cases
  2. Treatment for H. pylori
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is surgery indicated?

A

The acronym “I HOP”:

  1. Intractability
  2. Hemorrhage (massive or relentless)
  3. Obstruction (gastric outlet obstruction)
  4. Perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is a bleeding duodenal ulcer surgically corrected?

A

Opening of the duodenum through the pylorus
Oversewing of the bleeding vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What artery is involved with bleeding duodenal ulcers?

A

Gastroduodenal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

common surgical options for the following condition:

Truncal vagotomy?

A

Pyloroplasty

17
Q

common surgical options for the following condition:

Duodenal perforation?

A
  1. Graham patch (poor candidates, shock, prolonged perforation)
  2. Truncal vagotomy and pyloroplasty incorporating ulcer
  3. Graham patch and highly selective vagotomy
  4. Truncal vagotomy and antrectomy (higher mortality rate, but lowest recurrence rate)
18
Q

common surgical options for the following condition:

Duodenal ulcer intractability?

A
  1. PGV (highly selective vagotomy)
  2. Vagotomy and pyloroplasty