Q) In a patient 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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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.
Ia - Active Spurting Highest 90% chance of acute bleeding peptic ulcer ICD 10
Ib- Active oozing
IIa Non bleeding vessel 50% chance of rebleed
IIB Adherent clot
IIC Flat Pigmented spot
III Clean based ulcer
Sabiston 12o3 20th edition
Q) How to treat a bleeding peptic ulcer? Bleeding gastric ulcer management?
Steps to manage a bleeding peptic ulcer
- Secure two large bore IV lines for fluid and blood products. Evaluate for coagulopathy
- Simultaneous evaluation for source of bleeding and history. Important causes to rule out are chronic liver disease, NSAID use etc
- Simultaneous IV PPI infusion
- Endoscopic control of bleeding peptic ulcer- Thermal coagulation, hemoclips, Adrenaline injections etc
- Operative procedure For Duodenum bleed - Longitudanally opening the anterior wall of duodenum and 3 point suture ligation
- For Gatric ulcer bleeding - depends on the site of ulcer and might require Antrectomy/Partial gastrectomy
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