Complications of peptic ulcer Flashcards
3 locations of ulcers
eosphogeal,gastric, duodenal
t or F, pregnancy is a risk factor for complicated PUD
TRUE
risk of complication in NSAIDs is dependent on
3Ds, drug specific, dose speicifc, duration
which patients should receive prophylactic antacids
patients with multi-organ failure
name 4 physiological stautus at the time of pt presentation that predispose the pt to poor outcome (4)
- hypotension at time of admission 2. metabolic acidosis 3. acute renal failure 4. hypoalbuminermia
older age and comorbid disease are associated with
poor outcomes of PUD
List the 4 complications of ulcers
Bleeding, perfortation, penetration, stenosis
o Can present as Fresh blood vomiting
o OR Melina (black stool) = Digested blood/ oxidized by the acid
upper GI bleeding
what separates upper and lower GI bleeding?
ligament of treitz
diagnosis of bleeding is typically made via
endoscopy
in the management of bleeding, which drugs are discontinued
NSAIDs, warfarin, heparin
treatment of bleeding is done via
endoscopy (first) or surgery
when do you do surgery instead of endoscopy for pts w/ bleeding
- failed endoscpy 2. hemodynamic instability 3. recurrent hamorrhage 4. continued slow bleeding w/ tran exceeding 3 units/day, 5. big ulcer and wide area needs ligation
2/10 of of peptic ulcers are complicated by
perforations
quantify and name the area where perforations often take place
duodenal 60%
· Sudden epigastric pain and quickly becomes generalized.
· Pain may radiate to the top of the right shoulder or to both shoulders.which phase of perforation is the following:
initial- within 2 hours of onset
in which phase does abdominal rigidity take place?
initial
WHEN does the second phase of perforation occur
2-12 hours after onset
abdominal pain MAY lessen, marked board like rididity
2nd phase
increased abdominal distention, temperation elevation and hypovolemia are all characteristic of ___phase of perforation
3rd
when does the 3rd phase of perforation occur?
> 12 h
management of perforation
intravenous proton pump inhibitor, antibiotic, surgery.
most common organ that is penetrated
pancreas > lesser omentum > biliary tract (from duodenum) > liver (duodenum), the least would be vascular structures
antral and duodenal ulcers suggest which type of organ perforation
pancreas
