Bleeding Peptic Ulcer

Pathophysiology

  • Peptic ulcer erodes through the mucosa of the stomach or duodenum - erodes through blood vessel
  • Accounts for 50% of upper GI bleeds
  • GUs on lesser curvature may cause massive haemorrhage of left gastric artery
  • DUs on posterior wall are more likely to cause massive bleeding due to proximity to gastroduodenal artery

Clinical presentation

  • Haematemesis
  • Melaena
  • Abdominal discomfort
  • Dizziness
  • Sudden death

Investigations

  • Endoscopy

Management

  • Endoscopic treatment - adrenaline injection, heater probe coagulation, clips, haemospray
  • IV omeprazole
  • Theatre/patch repair if necessary (if can’t stop bleeding/rebleeding)
  • Eradicate H. pylori and start on PPIs