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Peptic Ulcer Bleeding

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Sun Yai-Cheng
Sun Yai-Cheng

Management of Acute Bleeding from a Peptic Ulcer N Engl J Med 2008;359:928-37.

1 of 19
Management of Acute Bleeding from a Peptic Ulcer August 28, 2008;359:928-937 Review Article
Epidemiology ,[object Object],[object Object]
Clinical Presentation ,[object Object],[object Object]
Priority in Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Priority in Treatment ,[object Object],[object Object],[object Object]
Nasogastric Tube and Acute Upper Gastrointestinal Bleeding ,[object Object],[object Object],[object Object],[object Object]
 
 
FORREST - classification of upper gastrointestinal hemorrhage Acute hemorrhage Forrest IA Active spurting hemorrhage Forrest IB Oozing hemorrhage Signs of recent hemorrhage Forrest IIA Non-bleeding visible vessel Forrest IIB Adherent clot Forrest IIC Hematin on ulcer base Lesions without active bleeding Forrest III Clean-base ulcers
Endoscopic Stigmata of Bleeding Peptic Ulcer, Classified as High Risk or Low Risk Spurt blood (grade IA) Ooze blood (grade IB) Nonbleeding visible vessel (grade IIA) Adherent clot (grade IIB) Flat, pigmented spot (grade IIC) Clean base (grade III)
High-risk — active bleeding or nonbleeding visible vessel (Forrest grade IA, IB, or IIA) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
High-risk — adherent clot (Forrest grade IIB) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Low-risk — flat, pigmented spot or clean base (Forrest grade IIC or III) ,[object Object],[object Object],[object Object],[object Object],[object Object]
After Endoscopy ,[object Object]
Predictors of failure of endoscopic treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Repeat Endoscopy ,[object Object],[object Object]
 
Surgery ,[object Object],[object Object],[object Object]
Interventional Radiology ,[object Object],[object Object]

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Peptic Ulcer Bleeding

  • 1. Management of Acute Bleeding from a Peptic Ulcer August 28, 2008;359:928-937 Review Article
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.  
  • 8.  
  • 9. FORREST - classification of upper gastrointestinal hemorrhage Acute hemorrhage Forrest IA Active spurting hemorrhage Forrest IB Oozing hemorrhage Signs of recent hemorrhage Forrest IIA Non-bleeding visible vessel Forrest IIB Adherent clot Forrest IIC Hematin on ulcer base Lesions without active bleeding Forrest III Clean-base ulcers
  • 10. Endoscopic Stigmata of Bleeding Peptic Ulcer, Classified as High Risk or Low Risk Spurt blood (grade IA) Ooze blood (grade IB) Nonbleeding visible vessel (grade IIA) Adherent clot (grade IIB) Flat, pigmented spot (grade IIC) Clean base (grade III)
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.  
  • 18.
  • 19.