Exposé: Different Faces of a Bleeding Giant Duodenal Ulcer
Stanford Multidisciplinary Seminars
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Case Presentation and Evolution
A 78-year old woman was brought to the Emergency Department by paramedics because of hematemesis, melena, and severe hypotension. She had a background history of mild dementia, chronic alcoholism and compensated alcoholic cirrhosis, chronic iron deficiency anemia, chronic left foot neuropathic ulceration, seizure disorder, and a remote history of breast cancer, cerebrovascular accident, and fall-related pelvic fracture. There was no history of prior cigarette smoking, or peptic ulcer disease. At presentation, she was lethargic, hypotensive (BP = 84/40) and mildly tachycardic and tachypneic. Her hemoglobin was 9.8 mg/dl, but after initial fluid boluses, it dropped to 7.4 despite the transfusion of two units of blood. She reported no abdominal pain. Her heart and lung examination was normal; her abdomen was obese but soft without organomegaly. She did not have any stigmata of cirrhosis or ascites. Electrocardiogram and troponin levels suggested demand...
- 7.Park SJ, Park H, Lee YC, et al. Effect of scheduled second-look endoscopy on peptic ulcer bleeding: a prospective randomized multicenter trial. Gastrointest Endosc. 2017. doi: 10.1016/j.gie.2017.07.024. [Epub ahead of print].
- 8.Chan, FKL, Lau JYW. Peptic ulcer disease. In: Sleisenger and Fordtran’s gastrointestinal and liver disease. Jan 1, 2016. pp. 884–900.e5. 2016.Google Scholar
- 10.Cheng HC, Yang EH, Wu CT, et al. Hypoalbuminemia is a predictor of mortality and re-bleeding in peptic ulcer bleeding under proton pump inhibitor use. J Formos Med Assoc. 2017. doi: 10.1016/j.jfma.2017.07.006. [Epub ahead of print].
- 11.Ardevol A, Ibañez-Sanz G, Profitos J, et al.. Survival of patients with cirrhosis and acute peptic ulcer bleeding compared with variceal bleeding using current first-line therapies. Hepatology. 2017 Jul 17. doi: 10.1002/hep.29370. [Epub ahead of print].
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