Treatment of choice of bleeding gastric ulcer:
M/C/C of UGI bleed = non-variceal bleed (80% - Non-Variceal bleed; 20% - variceal bleed) M/C/C of non-variceal UGI bleed = Peptic ulcer M/C site of Peptic ulcer = Duodenum (1st pa) Ulcer can be present on anterior or posterior wall of duodenum - Anterior wall ulcer - Perforate - Posterior wall ulcer - Bleed (as gastroduodenal aery runs behind the posterior wall of duodenum) M/C aery involved in duodenal ulcer = Gastroduodenal aery M/C aery involved in Gastric ulcer = Left gastric aery 1st investigation performed for UGI bleed = Endoscopy (both therapeutic and diagnostic) Treatment for bleeding gastric ulcer: "The principle of management of bleeding gastric ulcers are essentially the same. The stomach is opened at an appropriate position anteriorly and the vessel in the ulcer under-run. If the ulcer is not excised then a biopsy of the edge needs to be taken to exclude malignant transformation. Sometimes the bleeding is from the spienic aery and if there is a lot of fibrosis present then the operation may be challenging. However, most patients can be managed by conservative modality even if the incidence of recurrent bleeding is less"-Bailey 27/e page 1128 Treatment for bleeding Duodenal ulcer: - Duodenotomy; ligation of bleeding vessel; truncal vagotomy; pyloroplasty
TV and drainage
Antrectomy
Distal gastrectomy
Under running of ulcer
JIPMER 2017