Consult Surgery Emergently if a Patient With a Bleeding Peptic Ulcer Rebleeds after Endoscopic Control



Consult Surgery Emergently if a Patient With a Bleeding Peptic Ulcer Rebleeds after Endoscopic Control


Lee Ann Lau MD

Heidi L. Frankel MD



Peptic ulcer bleeding is a significant concern, with an incidence reported at 100 to 150 per 100,000 population per year. Approximately 5% of all intensive care unit (ICU) patients develop upper gastrointestinal bleeding, usually due to peptic ulcer disease or erosive gastritis. Most patients will not require endoscopy for diagnosis or treatment.


Signs and Symptoms

In the ICU patient, the diagnosis of bleeding due to peptic ulceration is made by bloody/coffee-ground nasogastric aspirate, emesis, or melena. Upper endoscopy is warranted when the bleeding is associated with decreasing hematocrit and/or hemodynamic instability. If active bleeding or signs of recent bleeding are identified during endoscopy, hemostatic therapies can be performed, including epinephrine injection to cause vasospasm, placement of clips to directly occlude the vessel, or heater probe application to coagulate the vessel. Nonsteroidal anti-inflammatory drug/aspirin treatment should be stopped in patients diagnosed with upper gastrointestinal bleeding. In addition, acid reduction must be instituted because lower gastric pH may cause clot lysis. Evidence supports the use of intravenous proton pump inhibitor in this setting. Despite aggressive endoscopic and medical management, rebleeding occurs in 15% to 20% of patients; therefore surgical consultation is imperative in all patients requiring urgent upper endoscopy.

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Jul 1, 2016 | Posted by in ANESTHESIA | Comments Off on Consult Surgery Emergently if a Patient With a Bleeding Peptic Ulcer Rebleeds after Endoscopic Control

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