Bleeding Peptic ulcer

Q) In a 55 year old male  with a bleeding peptic ulcer, endoscopy is done. Which of the following findings on endoscopy predicts the highest rate of re bleed?

a) Non bleeding vessel

b) Adherent clot

c) Flat pigmented spot

d) Clean base ulcer

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Free Answer 

Answer a

a) Non bleeding vessel IIA - Out of the choices given

Bleeding peptic ulcer is mostly from the posterior surface of the lesion and can be sometimes lethal

Forrest classification is used to grade the risk of re bleeding in peptic ulcers.

According to the stigmata of recent bleed, the chances of re bleed increase.

Endoscopic appearance of bleeding peptic ulcer classification

 Forrest Classification

Ia - Active Spurting                   Highest 90% chance of acute bleeding peptic ulcer ICD 10

Ib-  Active oozing

IIa Non bleeding vessel             50% chance of re bleed

IIB Adherent clot

IIC Flat Pigmented spot

III Clean based ulcer

Sabiston 1154 21th edition

Q) How to treat a bleeding peptic ulcer? Bleeding gastric ulcer management?

Steps to manage a bleeding peptic ulcer

  1. Secure two large bore IV lines for fluid and blood products. Evaluate for coagulopathy
  2. Simultaneous evaluation for source of bleeding and history. Important causes to rule out are chronic liver disease, NSAID use etc
  3.  Simultaneous IV PPI infusion
  4. Endoscopic control  of bleeding peptic ulcer- Thermal coagulation, hemoclips, Adrenaline injections etc
  5. Operative procedure For  Duodenum bleed - Longitudanally opening the anterior wall of duodenum and 3 point suture ligation
  6. For Gatric ulcer bleeding - depends on the site of ulcer and might require Antrectomy/Partial gastrectomy

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