VTE/ stress ulcers and bleeding

Question 1

Discuss stress ulcers

Answer 1

Mucosal erosions which may extend deeper into the submucosa of the upper GIT

Ulcers associated with head injury are referred to as cushing
those associated with burns are referred to as curling

Those ulcers probably occur as the consequnce of mucosal damage from upper GI ishcaemia or hypoxia and possibly reperfusion injury

Early effect resus is likley to be most effective in preventing the formation of ulcers

Question 2

Discuss risk factors for stress ulcer formation

Answer 2

Mechanical ventilation
perentral feeding
coagulopathic

Question 3

Discuss agents that can be used for ulcer prophylaxis`

Answer 3

H2 inhibitors
PPI
Prostaglandins

Ranitidine 50mg NG/IV q8hrly or famotidine 20mg BD
PPI are more effective at reducing acid secretion but have shown no benefit compared to H2 for prophylaxis

Use PPI if bleeding ulcer identified