Curling ulcer by Dr.K.AmrithaAnilkumar

CURLING ULCER
DEFINITION
They are acute ulcers which develop after major burns, presenting as pain in epigastric region, vomiting or haematemesis.
Curling’s ulcer occurs when burn injury is more than 35%.
It is observed in the body and fundus not in antrum and duodenum

1. e n love da Homoeopathy CURLING ULCER

2. CURLING ULCER

3. CURLING ULCER DEFINITION They are acute ulcers which develop after major burns, presenting as pain in epigastric region, vomiting or haematemesis . Curling’s ulcer occurs when burn injury is more than 35%. It is observed in the body and fundus not in antrum and duodenum

4. They are acute ulcers which develop after cerebral trauma or after neurosurgical operations. It is commonly single, deeper ulcer more frequently perforates. It can occur in oesophagus and duodenum also. BLEEDING PEPTIC ULCER HAEMORRAGE DEFINITION It is bleeding either from duodenal ulcer, or gastric ulcer or stomal ulcer. INCIDENCE Mortality in bleeding peptic ulcer is high (20–30 %).

5. CAUSES Elderly age, associated systemic diseases increase the mortality. NSAIDs and H. pylori infection, Coagulopathy, and anticoagulant drugs Concomitant use of NSAID & steroids increase risk by 10-fold. DUODENAL ULCER. BLEEDING DUODENAL ULCER 10% common. Risk of bleeding in chronic duodenal ulcer increases to 35% if patient has not taken specific anti Helicobacter pylori therapy and PPI.

6. . CAUSES Alcohol ™ NSAIDs steroids ™ Excessive fibrosis ™ Atherosclerotic disease PATHOLOGY Bleeding from DU is either from the small vessels (in the wall of ulcer crater or due to erosion into the gastroduodenal artery) ↓ Usually posterior duodenal ulcer bleeds. ↓ Bleeding from small vessels in the wall of ulcer is due to sloughing of the ulcer.

7. ↓ It is less severe, gradual and most often well-controlled by conservative treatment. ↓ Bleeding from erosion of gastroduodenal artery is severe, torrential and almost always needs early surgical intervention. CLINICAL FEATURES Haematemesis & melaena . Features of shock Pallor Tachycardia Sweating Hypotension Tachypnoea D ry tongue C old periphery . Past history of chronic DU may be present.

8. But it is not always necessary in every patient, as some may have a silent ulcer which may present as bleeding & haematemesis to begin with. History of pain and tenderness in epigastric region which has increased in intensity recently DIFF.DIAGNOSIS Erosive gastritis ™ Oesophageal varices ™ Carcinoma stomach ™ Bleeding gastric ulcer ™ Mallory-Weiss syndrome ™ Gastric polyps ™ Bleeding disorders

9. INVESTIGATION Estimation of serum electrolytes Blood urea, Serum creatinine, platelet count To look for in endoscopy, in bleeding ulcer Gastroscopy is confirmative Coeliac angiogram to identify the bleeder may be helpful TREATMENT Seventy percent of bleeding duodenal ulcers are treated conservatively. The shock is corrected initially by: Foot end elevation. IV fluids P lasma expanders ( haemaccel , dextran, crystalloids). CVP line is better in these patients.

10. Sedation. Catheterisation- to assess urine output. Blood transfusion to replace the lost blood Stomach wash is given—1 : 2,00,000 adrenaline in saline wash is given to the stomach through Ryle’s tube. Endoscopic cauterisation of small vessel with either gastroscopic bipolar cautery or through Laser Sclerotherapy—ethanolamine oleate , distilled water. Epinephrine injection is also used commonly. Observation Patients with bleeding from small vessels in the wall of DU will commonly respond to conservative treatment.

11. Angiographic embolisation of gastroduodenal artery. Haemoclips placement over the bleeding point endoscopically Surgery After laparotomy, pyloric channel and first part of the duodenum ( gastroduodenum ) GASTRIC ULCER BLEEDING DEFINITION It is similar to bleeding DU . Bleeding may be either from the ulcer bed or from the erosion of gastric vessels commonly but occasionally splenic vessels.

12. CLINICAL FEATURES Severe haematemesis and shock. Bleeding is much more severe than bleeding DU. TREATMENT Surgery is the main treatment After initial resuscitation, blood transfusion and a trial of conservative management, laparotomy is done Underrunning of the ulcer bed ™ Partial gastrectomy with Billroth Vagotomy with antrectomy ™ Occasionally splenic vessel ligation with splenectomy may be required.

13. REFERENCE SRB's Manual of Surgery by Sriram Bhat M 2. A Manual on Clinical Surgery by Das 3. A C oncise textbook of Surgery by Das

14. A Special Thanks To A Very Special Doctor