BGD 1Group A: Discuss Upper GI Bleeding due

to PUD

Gatchalian, Gaw, Geraldoy, Geronimo, Geronimo, Geronimo, Go, Go, Go, Go, Go, Go, Go, Go, Go

January 25, 2010

Clinical Presentation: History

• Epigastric painDU GU

Character • Burning or gnawing discomfort (DU and GU)• Ill-defined, aching sensation or as hunger pain

Pain Pattern • Occurs 90 min-3 h after a meal• Relieved by antacids or food• 2/3 of DU and 1/3 of NUD patients -

pain that awakes the patient from sleep (between midnight and 3 A.M.)

most discriminating symptoms

• Precipitated by food

Associated symptoms

• Nausea • Vomiting

Clinical Presentation: History

• Most common complication– ~15%– >60 years old 2° to the increased use of NSAIDs

• Up to 20% of patients with ulcer-related hemorrhage bleed without any preceding warning signs or symptoms

Tarry stools or coffee-ground

emesisBLEEDING

Clinical Presentation: History

• Second most common complication– 6–7% – High incidence in the elderly 2° to increased use

of NSAIDs

Sudden onset, severe, generalized abdominal pain PERFORATION

Clinical Presentation: History • PENETRATION is a form of perforation in which the ulcer bed

tunnels into an adjacent organ• DU: Pancreas Pancreatitis• GU: Left Hepatic Lobe Liver abscess, UGI hemorrhage, Subcapsular liver

abscess, or Liver rupture (uncommon; diagnosed during surgery or at autopsy) Li-Sheng, et.al., 2008

• Gastrocolic fistulas associated with GUs have also been described

Constant Dyspepsia

Not relieved by food or antacids

Radiates to the back

PENETRATING ULCER

(pancreas)

Clinical Presentation: History

• Least common ulcer-related complication• 1–2% of patients• Secondary to ulcer-related inflammation and edema in the peripyloric

region that resolves with ulcer healing• Secondary to scar formation in the peripyloric areas Fixed,

Mechanical Obstruction Endoscopic (balloon dilation) or Surgical intervention

Pain worsening with meals Early satiety

Nausea and Vomiting of

undigested foodWeight loss

GASTRIC OUTLET

OBSTRUCTION

Clinical Presentation: PE

• Epigastric tenderness– Most frequent finding in patients with GU or DU– Located at the right of the midline (20%)• Predictive value = low

Clinical Presentation: PE

Vomiting/Active GI blood loss Dehydration

TACHYCARDIA

ORTHOSTASIS

Gastric outlet obstruction SUCCUSSION SPLASH

Perforation SEVERLY Y TENDER, BROAD-LIKE ABDOMEN

References• Li-Sheng Hsu, Yuan-Hsiung Tsai, Wen-Ke Wang, Bor-Yau Yang.

Penetrating Gastric Ulcer Presenting as a Subcapsular Liver Abscess: a case report. Chin J Radiol 2008; 33: 103-107

• Harrison’s Principles of Internal Medicine 17th ed.