Peptic Ulcer Disease

Sores in the mucosal lining of the stomach or

first part of duodenum
Causes the erosion of the blood vessels
Bleeding can range from small oozing to brisk
bleeding

Who are at risk?

NSAIDs
aspirin
H. pylori

Clinical presentation

Epigastric pain
Nausea
Weight loss
Agitation, pallor, hypotension and tachycardia

Investigations

Hemoglobin
Urea and electrolytes
Cross match for transfusion
LFT
Prothrombin time
Early upper gastrointestinal endoscopy (within
12-24 hours)

Management
Close monitoring of blood pressure, pulse and
gross evidence of ongoing bleeding
cuffed endotracheal tube may be inserted

Indication for blood transfusion in

PATIENT WITH BLEEDING
1.Systolic BP < 110 mmHg
2.Postural hypotension
3.Pulse > 110/min
4.Haemoglobin <8g/dl
5.Angina or cardiovascular disease with a
Haemoglobin <10g/dl

ENDOSCOPIC THERAPY

Thermal
Injection
Mechanical
Combination

INJECTION THERAPY
Adrenaline
Sclerosant
Procoagulants

THERMAL MODALITIES
Multipolar coagulation
Heater probe

PHARMACOLOGICAL THERAPY
H2-receptor antagonists
Proton pump inhibitors

SURGERY
Massive bleeding
Ulcer inaccessible to endoscopic control