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Physical

Diagnostic Procedures | Vinnytsia 2012 | The male to female ratio for duodenal ulcer varies from 5:1 to 2:1, for gastric ulcer is 2:1 or less | Procedures | Management. |


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  1. Describe the physical features of the person sitting next to you.

· Hematemesis and melena should be noted which is indicative of bleeding from a gastroduodenal ulcer. The redder the stool, the more rapid the transit, which suggests a large upper tract hemorrhage. Digital rectal examination can be easily performed in the office to check for melena

· During vomiting, the lower esophagus and upper stomach are forcibly inverted. Vomiting attributable to any cause can lead to a mucosal tear of the lower esophagus or upper stomach. The depth of the tear determines the severity of the bleeding.

Lab Studies

Gastrin level: can identify the rare patient with gastrinoma as the cause of UGIB.

Treatment. Stabilize the patient with intravenous fluids (usually normal saline, except in patients with severe liver disease, ascites, or heart failure) and transfuse to maintain a hemoglobin level of 8-10 g. Promptly correct any abnormalities in coagulation. Baradarian et al demonstrated that early, aggressive resuscitation can reduce mortality in acute UGIB.7

The ideal pharmacologic therapy for patients with acute ulcer bleeding appears to be an intravenous PPI.

Surgical intervention usually provides definitive treatment of GOO, but it may result in its own comorbid consequences

· Cancer - Patients with gastric ulcers are also at risk of developing gastric malignancy.

o The risk is approximately 2% in the initial 3 years.

o One of the important risk factors is related to H pylori infection. H pylori is associated with atrophic gastritis, which, in turn, predisposes to gastric cancer.

o H pylori infection is associated with gastric lymphoma or mucosa-associated lymphoid tissue (MALT) lymphoma. The normal gastric mucosa is devoid of organized lymphoid tissue. H pylori infection promotes acquisition of lymphocytic infiltration and often forms lymphocytic aggregates and follicles from which MALT lymphoma develops. Eradication of H pylori is very important in this group of patients because eradication of H pylori has been shown to cause a remission of MALT lymphoma.


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