Chapter 39: UGI Bleed- GU

Question 1

In which age group are these ulcers most common?

Answer 1

• 40 to 70 years old (older than the duodenal ulcer population)
• Rare in patients age <40 years

Question 2

How does the incidence in men compare with that of women?

Answer 2

Men > women

Question 3

Which is more common overall: gastric or duodenal ulcers?

Answer 3

Duodenal ulcers are more than twice as common as gastric ulcers

(Think:Duodenal = Double rate)

Question 4

What is the classic pain response to food?

Answer 4

Food classically increases gastric ulcer pain

Question 5

What is the cause?

Answer 5

Decreased cytoprotection or gastric protection (i.e., decreased
bicarbonate/mucous production)

Question 6

Is gastric acid production high or low?

Answer 6

Gastric acid production is normal or low!

Question 7

What are the associated risk factors?

Answer 7

1. Smoking
2. alcohol
3. burns
4. trauma
5. CNS tumor/trauma
6. NSAIDs
7. steroids
8. shock
9. severe illness
10. male gender
11. advanced age

Question 8

What are the symptoms?

Answer 8

Epigastric pain
± Vomiting, anorexia, and nausea

Question 9

How is the diagnosis made?

Answer 9

• History,
• PE
• EGD
  
  • with multiple biopsies (looking for gastric cancer)

Question 10

What is the most common location?

Answer 10

• ≈70% are on the lesser curvature;
• 5% are on the greater curvature

Question 11

When and why should biopsy be performed?

Answer 11

• With all gastric ulcers, to rule out gastric cancer
• If the ulcer does not heal in 6 weeks after medical treatment
  
  • rebiopsy must be performed
• always boiopsy in OR

Question 12

What is the medical treatment?

Answer 12

Similar to that of duodenal ulcer—

1. PPIs or H2 blockers
2. H. pylori treatment

Question 13

When do patients with gastric ulcers need to have an EGD?

Answer 13

1. For diagnosis with biopsies
2. 6 weeks postdiagnosis to confirm healing and rule out gastric cancer!

Question 14

What are the indications for surgery?

Answer 14

The acronym “I CHOP”:

1. Intractability
2. Cancer (rule out)
3. Hemorrhage (massive or relentless)
4. Obstruction (gastric outlet obstruction)
5. Perforation

(Note: Surgery is indicated if gastric cancer cannot be ruled out)

Question 15

What is the common operation for hemorrhage, obstruction, and
perforation?

Answer 15

Distal gastrectomy with excision of the ulcer without vagotomy unless there is duodenal disease (i.e., BI or BII)

Question 16

What is a common option for a poor operative candidate with a
perforated gastric ulcer?

Answer 16

Graham patch

Question 17

What must be performed in every operation for gastric ulcers?

Answer 17

Biopsy looking for gastric cancer