Natural History of Upper GI Bleeding From PUD

When examining a patient for PUD, it is important to determine which subgroup of patients has an increased risk for the development of upper GI bleeding. Of the possible causes of upper GI bleeding, PUD remains the most frequent. If a patient required a blood transfusion with a previous PUD GI bleed, there is a more significant risk for re-bleeding. ASA or NSAIDs use and H. pylori presence suggest a PUD-related cause for the GI bleeding. The use of anticoagulation is particularly important because anticoagulation and antiplatelet agents generally increase the amount of bleeding and dictate changes in therapy to include reversal of anticoagulation and the timing for an endoscopic therapy. Patients in an ICU have other coexistent medical problems that increase their overall morbidity and mortality in the setting of an upper GI bleed. Patients with ZE syndrome who present with upper GI bleeding generally will have uncontrolled gastric acid secretion. Close attention to fluid imbalances as a result of the gastric acid hypersecretion (ie, up to 4 L/day of losses) will need to be addressed as well as volume losses from GI bleeding (Oh and Pisegna, 2003). High doses of intravenous (IV) proton pump inhibition are usually necessary in these patients.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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