In group 1 the sensitivity of the RUT decreased from 0.96 when no blood was present to 0.60 when blood was present (p = 0.006). The sensitivity of (13)C-urea breath test was not affected by blood in the stomach. [ncbi.nlm.nih.gov]

• Anemia

  Instead of transporting oxygen and nutrients, the blood pools and causes anemia. Symptoms of anemia and blood loss are dizziness, loss of skin tone or coloring resulting in a pale appearance and general fatigue. [livestrong.com]

  As a result there can be slow blood loss which may lead to anemia, or there may be massive blood loss with severe complications in the short term. [healthhype.com]

  A blood test for anemia may be done, and a stool sample may be checked for the presence of blood. Both of these tests can indicate a bleeding ulcer. [health.harvard.edu]

• Pallor

  Slow bleeding is typically from a small blood vessel; the usual result is low blood count (anemia), and the symptoms are tiredness ( fatigue ), lethargy, and pallor. [emedicinehealth.com]

• Gangrene of the Toe

  The patient was a woman aged 78 years who had a history of ischemic heart disease and gangrene of the toes. She developed an aspirin-related bleeding duodenal ulcer and died of congestive heart failure despite successful endoscopic hemostasis. [annals.org]

• Familial Adenomatous Polyposis

  The familial polyposis syndromes produce diffuse adenomatous polyposis, resulting in studding of the mucosa with often nearly confluent polyps, all of roughly the same size. [hawaii.edu]

• Melena

  RESULTS: 263/500 (52.6%) were taking NSAIDs before the acute bleeding. 70/96 (72.9%) patients with red haematemesis showed haemodynamic changes vs 15/107 (14%) with dark haematemesis and melena, and 29/281 (10.3%) with melena alone, p < 0.01, OR = 20. [ncbi.nlm.nih.gov]

  Diagnosis UGI bleeding in children often presents with large-volume hematemesis and can be from either a variceal or non-variceal (peptic-ulcer) source or with coffee-ground emesis or melena. [clinicaladvisor.com]

  Acute hemorrhage from upper gastrointestine was defined as classical presentation with hematemesis, coffee-ground emesis, and/or melena. [clinicaltrials.gov]

  After endoscopic treatment, patients were randomly assigned to receive either: Omeprazole, 80mg bolus, then continuous infusion of 8mg/hr for 72 hours Placebo Recurrent bleeding defined as: Vomiting fresh blood Shock (SBP 110bpm) with melena after stabilization [wikijournalclub.org]

• Dyspepsia

  NSAID users may be classified as low or high risk, according to the absence or presence of one or more of the following factors associated with an increased risk of bleeding: co-morbidities; corticosteroid or anticoagulant co-therapy; previous dyspepsia [ncbi.nlm.nih.gov]

  […] ground, 1, 2 and apparently with good reason, as the increased abnormal psychic stimuli created by the advent of the war and the need for adjustment to a new environment are all reflected in the many reports of an appreciable increase in the incidence of dyspepsia [annals.org]

  The British Society of Gastroenterology defines dyspepsia as a group of symptoms that alert doctors to consider disease of the upper gastrointestinal tract, and states that dyspepsia itself is not a diagnosis. [pathways.nice.org.uk]

  Symptoms Dyspepsia The most common symptoms of peptic ulcer are known collectively as dyspepsia, or symptoms of indigestion. [pennstatehershey.adam.com]

• Epigastric Pain

  There is sudden, intense, continuous epigastric pain that spreads rapidly throughout the abdomen, often becoming prominent in the right lower quadrant and at times referred to one or both shoulders. [merckmanuals.com]

  CLINICAL FEATURES Typical symptoms of peptic ulcer disease include episodic gnawing or burning epigastric pain; pain occurring two to five hours after meals or on an empty stomach; and nocturnal pain relieved by food intake, antacids, or antisecretory [aafp.org]

  A physical examination may reveal pain, epigastric tenderness, or abdominal distention. Barium study. A barium study of the upper GI tract may show an ulcer. Endoscopy. [nurseslabs.com]

• Black Stools

  When symptoms occur, they include: A gnawing or burning pain in the middle or upper stomach between meals or at night Bloating Heartburn Nausea or vomiting In severe cases, symptoms can include: Dark or black stool (due to bleeding) Vomiting Weight loss [my.clevelandclinic.org]

  Black stool from blood is called maleana and from food supplements or foods like karo (atapa) is called false maleana. [monitor.co.ug]

  Sometimes, stomach ulcers can lead to more serious symptoms, such as: a sudden sharp pain in your stomach that gets worse vomiting blood blood in your stool (poo) or black stools. If you have any of these symptoms, see a doctor immediately. [healthdirect.gov.au]

  Signs of a bleeding ulcer include lightheadedness, dizziness, and black stools. Scar tissue: This is thick tissue that develops after an injury. This tissue makes it difficult for food to pass through your digestive tract. [healthline.com]

• Gastropathy

  Additional etiologic factors Any of the following may be associated with PUD: Hepatic cirrhosis Chronic obstructive pulmonary disease Allergic gastritis and eosinophilic gastritis Uremic gastropathy Henoch-Schönlein gastritis Corrosive gastropathy Bile [emedicine.medscape.com]

  In the case of the older child or adolescent with this presentation, consideration needs to be given to NSAID-induced gastropathy arising from self-medication. [hawaii.edu]

• Hypotension

  Multiple logistic regression analysis revealed that hypotension (odds ratio (OR) 2.21, 95% confidence interval (CI) 1.40-3.48), haemoglobin level less that 10 g/dl (OR 1.87, 95% CI 1.18-2.96), fresh blood in the stomach (OR 2.15, 95% CI 1.40-3.31), ulcer [ncbi.nlm.nih.gov]

  They included hypotension, hemoglobin 2cm and active bleeding during endoscopy [Wong Gut 2003]. [clinicaltrials.gov]

  Place the patient in the recumbent position with the legs elevated to prevent hypotension, or place the patient on the left side to prevent aspiration from vomiting. Treat hypovolemic shock as indicated. [nurseslabs.com]

  Rebleeding was defined as patients who, during hospitalization, presented one or more of the following signs: hematemesis, persistent melena (during reevaluation in 12 and 24 h), enterorrhagia, hypotension (fall of the sistolic pressure ³ 25 mm Hg or [scielo.br]

  Fever, hypotension, and oliguria suggest sepsis and circulatory compromise. [aafp.org]

• Tachycardia

  Note and report symptoms of perforation (sudden abdominal pain, referred pain to shoulders, vomiting and collapse, extremely tender and rigid abdomen, hypotension and tachycardia, or other signs of shock). [nurseslabs.com]

  […] patients who, during hospitalization, presented one or more of the following signs: hematemesis, persistent melena (during reevaluation in 12 and 24 h), enterorrhagia, hypotension (fall of the sistolic pressure ³ 25 mm Hg or diastolic pressure ³ 15 mm Hg), tachycardia [scielo.br]

  In a prospective study of patients presenting with hematochezia plus hypotension, tachycardia, dropping hemoglobin, or transfusion, and a negative NG aspirate, 15% had an upper GI source (27). [gi.org]

• Guillain-Barré Syndrome

  Acinetobacter baumannii Xanthomonadaceae Stenotrophomonas maltophilia Cardiobacteriaceae Cardiobacterium hominis HACEK Aeromonadales Aeromonas hydrophila / Aeromonas veronii Aeromonas infection ε Campylobacterales Campylobacter jejuni Campylobacteriosis, Guillain–Barré [en.wikipedia.org]

(See Workup .) Upper GI endoscopy is the preferred diagnostic test in the evaluation of patients with suspected PUD. [emedicine.medscape.com]

Minimum blood workup in all patients should include blood-typing and cross-matching for an appropriate number of units of packed red blood cells along with determinations of hemoglobin, hematocrit, platelets, coagulation time, and electrolytes. [7] Hypovolemic [saudijgastro.com]

Many times, the workup of the crampy patient with modest bleeding in loose mucusy stools involves a quick survey of inflammatory markers and a 2 to 3 day wait for the culture results from the rectal swab. [hawaii.edu]

Victims of penetrating trauma with signs of peritonitis require surgical exploration without further diagnostic workup. [wjes.biomedcentral.com]

Abstract In managing patients with bleeding peptic ulcers, it has been reported that pharmacologic treatment can be an alternative to endoscopic treatment. [ncbi.nlm.nih.gov]

Because of a more aged and more diseased ulcer population, the long-term prognosis may be expected as poor. [ncbi.nlm.nih.gov]

Prognosis The prognosis of an adequately treated peptic ulcer in children is excellent. Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved. [clinicaladvisor.com]

Kraus M, Mendeloff G, Condon RE (1976) Prognosis of gastric ulcer: twenty-five year follow-up. Ann Surg 184: 471–476 Google Scholar 10. Manegold BC (1975) Emergency endoscopy in upper gastrointestinal bleeding. [link.springer.com]

In the rare cases when surgery cannot be done, prognosis is poor. Obstruction may be caused by scarring, spasm, or inflammation from an ulcer. [merckmanuals.com]

Several etiologic factors of peptic ulcer are known, the principle one being Helicobacter pylori (H. pylori). Recent studies indicate that H. pylori eradication is associated with the marked reduction in rebleeding rate. [ncbi.nlm.nih.gov]

There is no increased risk of cancer with ulcers of other etiology. [merckmanuals.com]

Bleeding is the most common and serious PUD complication, and mortality is 5% to 10%. 6 Treatment Etiology and presentation dictate treatment (Table 2); supportive care, acid reduction, and endoscopic hemostasis are the cornerstone of treatment. [pharmacytimes.com]

Author information 1 Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Denmark. [email protected] Abstract Systemic glucocorticoid use is associated with an increased risk for peptic ulcer bleeding (PUB); however, little is known about [ncbi.nlm.nih.gov]

Steering Committee Gastrointestinal Haemorrhage, British Medical Journal, 311(6999), 222-226. [ 8 ] Leerdam, V. (2008) Epidemiology of acute upper gastrointestinal bleeding. [dx.doi.org]

Ms Feinstein previously worked in the area of foodborne epidemiology at the Centers for Disease Control and Prevention. She is now a PhD candidate at the University of North Carolina, Chapel Hill, focusing on the epidemiology of infectious diseases. [wwwnc.cdc.gov]

Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 51. BACK TO TOP [centurahealthinfo.org]

Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 51. Updated by: Michael M. [nlm.nih.gov]

Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 51. Version Info Last reviewed on 4/2/2018 Michael M. [pennmedicine.org]

If routine second-look endoscopy was 100% effective in preventing rebleeding, then the rebleeding threshold for cost neutrality would be 17.5%. [ncbi.nlm.nih.gov]

Some of these fatalities could probably be avoided with improved preventive measures. [sbu.se]