PEPTIC ULCER IN GIT

HAEMORRAGE
(FORREST CLASSIFICATION)
 DEFINATION OF ULCER
• Ulcer: An area of tissue erosion, for example, of the
skin or lining of the gastrointestinal (GI) tract. Due to
the erosion, an ulcer is concave. It is always
depressed below the level of the surrounding tissue.
• Ulcers can have diverse causes.
• Ulcers in the GI tract were once attributed to stress
but most are now believed to be due to infection
with the bacteria H. pylori. GI ulcers, however, may
be made worse by stress, smoking and other
noninfectious factors.
 PREVALENCE
• Common medical emergency

• Consistant hospital mortality of 10-15%

• Incidence is about 100 per 100000 population per

year world wide

• Main casualties are the elderly with co-morbidities

• Commonest cause of Upper GI bleed is peptic ulcer

disease
 CAUSES OF UPPER GIT BLEED
Non Variceal Bleding – Peptic Ulcer Diseasae

• Risk factors
– Nsaids
• 15-30% of patients using nsaids will have ulcer disease
• Smaller number have bleeding and perforation
• Risk increase in elderly with comorbidities, higher dose of NSAIDS,
concommitant steroids and anticoagulation
– Aspirin
• Any dose of aspirin has potential of GI bleed
• Concommitant use of nsaid increases risk
– Helicobacter pylori
• Main cause of uncomplicated PUD
• Eradication reduces risk of recurrent ulcer and rebleeding
– Cirrhosis
 CAUSES OF UPPER GI BLEED
Oesophagus
• Esophageal varices

• Mallory weiss tear

• Reflux esophagitis

• Esophageal ulcer

• Esophageal carcinoma
 CAUSES OF UPPER GIT BLEED
Stomach

– Gastric ulcer

– Gastric erosions

– Gastric cancer

– Gastric varices

– Lymphoma

– Gastric polyps
 CAUSES OF UPPER GIT BLEED
• Duodenum

1)Duodenal ulcer
2)Duodenal erosions
3)Carcinoma pancreas
4)Haemofilia
 FORREST CLASSIFICATION

• DEVIDED INTO 3 TYPE

A)FORREST I: FORREST IA & FORREST IB
B)FORREST II: FORREST IIA, FORREST IIB, FORREST IIC
C)FORREST III
• TO SIMPLIFIED THE FINDING AND
TREATMENT NEEDED
 Risk of re-bleeding by Forrest
grade
Patients with endoscopic or clinical rebleeding within 72 hours (%)

100

80
Forrest Ia Forrest IIa Forrest IIb Forrest IIc Forrest III
(after endoscopic
haemostasis)
60

40 38.7
28.8
19.6
20
13.2
5.1
0

Lau JY, et al. Endoscopy 1998;30:513–8

A) FORREST I ULCER

1) FORREST 1A
2) FORREST 1B
 1) FORREST 1A

• SPURTING HAEMORRAGE TYPE ORIGIN FROM

ARTERY.
• MAY CAUSE DEATH IF NO EMERGENCY
TREATMENT GIVEN
FORREST 1A

Spurting
bleeding
 2) FORREST IB

• OOZING TYPE HAEMORRAGE

• MAY CAUSE DEATH IF NOT TREAT AS SOON AS
POSSIBLE
 FORREST IB

OOZING AROUND
ULCER
B) FORREST II ULCER

1) FORREST IIA
2) FORREST IIB
3) FORREST IIC
1) FORREST IIA

VISIBLE
BLOOD
VESSEL
2) FORREST IIB

BLOOD
CLOT
3) FORREST IIC

HEMATIN
AT ULCER
FORREST III

CLEAN BASE
WITH WHITE
LAYER AT ULCER.
NO RECENT SIGN
OF BLEED.
 ENDOSCOPIC HAEMOSTASIS
Epinephrine injection
plus

either
heater probe
haemoclips
 ADVICE

• REDUCE CAFFIEN INTAKE

• REDUCE SMOKING, STOP IS BETTER
• AVOID ACIDIC FOOD AND BAVERAGE & SPICY
DISHES
• WATCH FOR MEDICINE INTAKE. MOSTLY FROM
NSAIDS
• HEALTHY LIFE STYLE
THANK
YOU