1. 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

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 Tarry stools or coffee-ground emesis BLEEDING

4. Clinical Presentation: History Second most common complication – 6–7% – High incidence in the elderly 2° to increased use of NSAIDs Sudden onset, severe, generalized abdominal pain PERFORATION

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, Subcapsular liver 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 Constant Dyspepsia Not relieved by food or antacids Radiates to the back PENETRATING ULCER (pancreas)

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 Pain worsening with meals Early satiety Nausea and Vomiting of undigested food Weight loss GASTRIC OUTLET OBSTRUCTION

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 Vomiting/Active GI blood loss DehydrationTACHYCARDIAORTHOSTASIS Gastric outlet obstruction SUCCUSSION SPLASHPerforation SEVERLY Y TENDER, BROAD-LIKE ABDOMEN

9. References Li-Sheng Hsu, Yuan-Hsiung Tsai, Wen-Ke Wang, Bor-Yau Yang. Penetrating Gastric Ulcer Presenting as a Subcapsular Liver Abscess: a case report. Chin J Radiol 2008; 33: 103-107 Harrison’s Principles of Internal Medicine 17 th ed.