Upper GI Bleeding – Topics in General Surgery

Topics, Upper GI Bleeding

Upper GI (gastrointestinal) Bleeding

  • bleeding proximal to the ligament of Trietz
  • Most common cause of UGI bleeding is Duodenal Ulcer (25%), Gastric ulcer (20%), Acute Gastritis (15%)
  • EGD is the diagnostic test of choice with UGI bleeding

Peptic Ulcer Disease

  • Both gastric and duodenal ulcers

Duodenal Ulcers

  • Caused by increased gastric acid production
  • ZE syndrome (zollinger ellison) is a risk factor

Surgeries for duodenal ulcers

  • Graham patch
  • Truncal Vagotomy and pyloroplasty
  • Truncal Vagotomy and antrectomy with Billroth I (one limb off the stomach remnant)
  • Truncal Vagotomy and antrectomy with Billroth II (2 limbs off stomach remnant)
  • Proximal gastric vagotomy (Highly selective)
  • Truncal Vagotomy – removal of a segment of vagal trunk on the distal esophagus, this decreases gastric acid secretion
  • Drainage procedure is needed with Truncal Vagotomy

Gastric Ulcers

  • Due to decreased cytoprotection, gastric acid is usually normal or low.
  • Most of  the gastric ulcers (70%) are on the lesser curvature.  5% is on the greater curvature.
  • With all gastric ulcers, must rule out gastric cancer  – need biopsy

Mallory Weiss Syndrome

  • Postemesis longitudinal tear
  • Do not use sengstaken-blakemore balloon

Esophageal Variceal Bleeding

  • Need to verify bleeding with EGD.  Only 50% of UGI bleeding in patients with known Esophageal Varices are bleeding from varices.
  • Treatment:  sengstaken-blakemore balloon, Liver transplant, shunts (ie. Warren)