Chapter 39: UGI Bleed- DU Flashcards
In which age group are these ulcers most common?
40 to 65 years of age (younger than patients with gastric ulcer)
What is the ratio of male to female patients?
Men > women (3:1)
What is the most common location?
Most are within 2 cm of the pylorus in the duodenal bulb
What is the classic pain response to food intake?
Food classically relieves duodenal ulcer pain
(Think: Duodenum = Decreased with food)
What is the cause?
Increased production of gastric acid
What syndrome must you always think of with a duodenal ulcer?
Zollinger–Ellison syndrome (ZES)
What are the major symptoms?
- Epigastric pain
- Bleeding
What are the signs?
- Tenderness in epigastric area (possibly)
- guaiac-positive stool
- melena
- hematochezia
- hematemesis
What is the differential diagnosis?
- Acute abdomen
- pancreatitis
- cholecystitis
- all causes of UGI bleeding
- ZES
- gastritis
- MI
- gastric ulcer reflux
How is the diagnosis made?
- History
- PE
- EGD
- UGI series (if patient is not actively bleeding)
When is surgery indicated with a bleeding duodenal ulcer?
Most surgeons use: (OR)
- >6 unit PRBC transfusions
- >3 unit PRBCs needed to stabilize
- for significant rebleed
What is the medical treatment?
- Proton-pump inhibitors (PPIs) or H2 receptor antagonists—heals ulcers in 4 to 6 weeks in most cases
- Treatment for H. pylori
When is surgery indicated?
The acronym “I HOP”:
- Intractability
- Hemorrhage (massive or relentless)
- Obstruction (gastric outlet obstruction)
- Perforation
How is a bleeding duodenal ulcer surgically corrected?
Opening of the duodenum through the pylorus
Oversewing of the bleeding vessel
What artery is involved with bleeding duodenal ulcers?
Gastroduodenal artery
common surgical options for the following condition:
Truncal vagotomy?
Pyloroplasty
common surgical options for the following condition:
Duodenal perforation?
- Graham patch (poor candidates, shock, prolonged perforation)
- Truncal vagotomy and pyloroplasty incorporating ulcer
- Graham patch and highly selective vagotomy
- Truncal vagotomy and antrectomy (higher mortality rate, but lowest recurrence rate)
common surgical options for the following condition:
Duodenal ulcer intractability?
- PGV (highly selective vagotomy)
- Vagotomy and pyloroplasty
