bleeding duodenal ulcer
- 80 % of upper GI bleeding are self limited.
- 10 % mortality rate of upper GI bleeding,who continues to bleed,or recurred.
- endoscopy is utilized for the following; to identify the cause,severity and for therapy.
risk of mortality increase with following, compared to non.
- age older than 60 ( 9 % below 60--13 % older than 60)
- severe initial bleeding which comes with the following: ( presence of shock,high transfusion requirements,or bright blood on NGT )
- recurrent bleeding ( increase from 8 % up to 45 % )
- bleeding onset ( 33 % for hospital start compared to 7 % for bleeding onset before admission)
- co morbid conditions ( 3 or more ) : cardiac,CNS,renal,GI,hepatic,pulmonary,neoplastic,stress ( 2 % if non,compared to 15 % for three disease ,65 % if 6 diseases)
- stigmata of recent bleeding from PU,( visible vessel on endoscopy,oozing of bright red blood,fresh or old blood clot on the base of the ulcer)
- emergency surgery associated with 30 % mortality compared to 10 % going for elective surgery.
- bleeding severity :( if no transfusion , mortality is 2%) ( if 1-3 units transfused , mortality is 5% )( if 4-6 units transfused , mortality is 12 % ) ( if 7-9 nits transfused , mortality is 15 % ) (if more than 10 units transfused , mortality is 35 % )
endoscopy findings and its implications
- visible vessel associated with 50 % re bleeding rate.the only type associated with mortality compared to others
- other endoscopy finding associated with 8 % chance of re bleeding rate.
- pumping or oozing lesion is associated with 15 % mortality,and 25 % need for surgery.transfusion requirement more than 5 units approach 35 %, re bleeding rate is 10 %.
- clot or no blood is associated with 5 mortality,and 10 % need for surgery.(compare to pumping or oozing ulcer).risk of re bleeding approach 30%. transfusion requirements more than 5 units about 20 %
