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BGD 1 Group A: Discuss Upper GI Bleeding due to PUD

BGD 1 Group A: Discuss Upper GI Bleeding due to PUD. Gatchalian , Gaw , Geraldoy , Geronimo, Geronimo, Geronimo, Go, Go, Go, Go, Go, Go, Go, Go, Go January 25, 2010. Clinical Presentation: History. Epigastric pain. Clinical Presentation: History. Most common complication ~15%

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BGD 1 Group A: Discuss Upper GI Bleeding due to PUD

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  1. BGD 1Group A: Discuss Upper GI Bleeding due to PUD Gatchalian, Gaw, Geraldoy, Geronimo, Geronimo, Geronimo, Go, Go, Go, Go, Go, Go, Go, Go, Go January 25, 2010

  2. Clinical Presentation: History • Epigastric pain

  3. Clinical Presentation: History • Most common complication • ~15% • >60 years old 2° to the increased use of NSAIDs • Up to 20% of patients with ulcer-related hemorrhage bleed without any preceding warning signs or symptoms

  4. Clinical Presentation: History • Second most common complication • 6–7% • High incidence in the elderly 2° to increased use of NSAIDs

  5. Clinical Presentation: History • PENETRATION is a form of perforation in which the ulcer bed tunnels into an adjacent organ • DU: Pancreas  Pancreatitis • GU: Left Hepatic Lobe Liver abscess, UGI hemorrhage, Subcapsularliver abscess, or Liver rupture (uncommon; diagnosed during surgery or at autopsy) Li-Sheng, et.al., 2008 • Gastrocolic fistulas associated with GUs have also been described

  6. Clinical Presentation: History • Least common ulcer-related complication • 1–2% of patients • Secondary to ulcer-related inflammation and edema in the peripyloric region that resolves with ulcer healing • Secondary to scar formation in the peripyloric areas  Fixed, Mechanical Obstruction  Endoscopic (balloon dilation) or Surgical intervention

  7. Clinical Presentation: PE • Epigastric tenderness • Most frequent finding in patients with GU or DU • Located at the right of the midline (20%) • Predictive value = low

  8. Clinical Presentation: PE

  9. References • Li-ShengHsu, Yuan-Hsiung Tsai, Wen-KeWang, Bor-YauYang. Penetrating Gastric Ulcer Presenting as a SubcapsularLiver Abscess: a case report. Chin J Radiol 2008; 33: 103-107 • Harrison’s Principles of Internal Medicine 17th ed.

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