| name: | Bleeding Ulcer |
| also known as: | Ulcer Hemorrhage; Vomiting Blood; Hematemesis; Melena; Hematochezia; Melaena |
| also see: | Gastric Ulcer; Duodenal Ulcer; Repair Perforated Ulcer; Intestinal Perforation; Upper GI Bleeding; Lower GI Bleeding; ICD |
| description: | An ulcer is a small erosion of the internal lining of the stomach (stomach ulcer, gastric ulcer) or the first part of the large intestine (duodenal ulcer) that has eroded deeper than just the top mucosal lining (gastric erosion). A peptic ulcer is either a gastric ulcer or a duodenal ulcer. The three principle complications of peptic ulcers include bleeding ulcer, perforation, and obstruction. Bleeding is the most common serious complication of gastric ulcer, but can also occur from portal hypertension, Mallory Weiss tear and gastritis. About 75% of bleeding ulcers will stop without surgical intervention, only requiring intensive supportive care. The remainder will require surgery, or will go on to die. A distinction needs to be made between bleeding from a bleeding ulcer that comes up out of the mouth, such as vomiting blood (hematemesis), called an upper bleed, and bleeding from a bleeding ulcer that goes down out the bowels which usually presents as black tarry stools (melena). |
| signs & symptoms: | 1. Vomiting up bright red blood=active bleeding esophagus, stomach, duodenum 2. Vomiting up coffee ground blood=inactive bleeding esophagus, stomach 3. Passing black tarry stools=old blood anywhere along the intestines 4. Passing red bleeding stools=active bleeding colon, rectum, anus |
| diagnosis: | Based on signs, symptoms, history, exam, as well as a blood count, an x-ray of the upper digestive tract, called a barium swallow and an upper GI endoscopy. |
| treatment: | Might include first stabilizing the patient, if necessary, including IV fluids, and treating for shock if needed, blood count, preparing blood for possible blood transfusion, placement of a tube through the nose into the stomach for gastric lavage, called a nasogastric tube, and upper GI endoscopy for diagnostic purposes and possibly therapeutic purposes, such as sclerosing the bleeding vessel or using a YAG or argon laser, if found. If the bleeding stops, H2 blockers are usually prescribed. Those persons who have rapid blood loss, or who fail medical management, such as requiring 1 unit of transfused blood every 8 hours to maintain stability, probably require emergency surgery. The same is true for those who initially stop bleeding and then start up again. Surgery involves an exploratory laparotomy and anyone of several procedures, depending upon where the bleeding site is. Bleeding duodenal ulcers can be treated with ligation (tying off) the bleeding vessel, gastrectomy, vagotomy or a gastrojejunostomy. Bleeding gastric ulcers can be treated with gastrectomy, vagotomy and pyloroplasty. |
| prevention: | Avoid causes and risks. |
| outcome: | Prognosis is worse for those over 75, and those with comorbid illnesses, shock, ascites, and abnormal coagulation test. |
skynetMD suggests the following:
| if: | If the person has signs of active intestinal bleeding, such as vomiting up bright red blood (hematemesis), vomiting up coffee grounds appearing blood, passing bright red blood per rectum, or, if the person has signs of shock such as lightheadedness, weakness, confusion |
| go to: | Go to the phone and dial 911 or go to the hospital for emergency care. |
| if: | If the person develops signs of an ulcer, such as a burning boring gnawing pain that lasts several hours, along with recurrent vomiting, vomiting up blood, black tarry stools, anemia, paleness, fatigue, weight loss, loss of appetite |
| go to: | Go to the doctor |
| if: | If the person has signs of a gastric erosion, such as black tarry stools, occasional vomiting up bright red blood or vomit that looks like coffee grounds |
| go to: | Go to the doctor |
| if: | If the person has the diagnosis of a gastric ulcer, and is under the care of a doctor, they should avoid coffee, caffeine, alcohol, smoking, stress. They should eat a well balanced diet high in dietary fiber with 3 meals a day, and without over eating, exercise, and |
| go to: | Go to the pharmacy for over the counter nonprescription antacids for minor pain and for over the counter nonprescription acid inhibiting drugs that promote healing, also called H2 blockers and proton pump inhibitors. |
Last updated 6/12/2008