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Peptic Ulcer, Emergency Medicine

Yanina Purim-Shem- Tov Reviewed 06/2017
 


Basics

Description

  • Produced by breakdown in gastric or duodenal mucosal defenses

  • Imbalance exists between production of acid and ability of mucosa to prevent damage.

Etiology

  • Helicobacter pylori:

    • Gram-nega...

Diagnosis

Signs and Symptoms

  • Epigastric pain or tenderness (80–90%):

    • Burning, gnawing, aching pain

    • Location: midline, xiphoid, or umbilicus

  • Duodenal ulcers:

    • Pain occurs 90 min–3 hr after meals

    • Usually awake...

Treatment

Pre-Hospital

  • ABCs

  • IV fluid resuscitation for hypotensive/shock patients

Initial Stabilization/Therapy

  • ABCs

  • Identify ulcer complications (hemorrhage, perforation, obstruction)

  • Treat hypotension wit...

Follow-Up

Disposition

Admission Criteria

  • Gastric obstruction

  • Perforation

  • Active upper GI bleed

  • Melena

  • Uncontrolled pain

  • Anemia requiring transfusion

Discharge Criteria

  • Unremarkable physical exam with normal CB...

Pearls and Pitfalls

  • H. pylori is the most common cause of PUD.

  • NSAID-induced PUD is frequently silent.

  • Dyspeptic symptoms are nonspecific.

  • Endoscopy is diagnostic and should include H. pylori screening.

  • T...

Additional Reading

  • Chey  WD, Wong  BC, Practice Parameters Committee of the American College of Gastroenterology. American College of Gastroenterology guideline on the management of Helicobacter pylor...

Codes

ICD9

  • 531.30 Acute gastric ulcer without mention of hemorrhage or perforation, without mention of obstruction

  • 532.30 Acute duodenal ulcer without mention of hemorrhage or perforation, without menti...

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