Erosion of gastric mucosa, with resultant bleeding and pain
Most common cause of UGIB
Risk Factors
ETOH
H pylori
NSAIDs, steroids, other meds
Severe illness/stress (head trauma, burns, ICU stays)
Zollinger Ellison (ZE) - very rare; from gastrinoma (located in pancreas)
Symptoms
Range from painless to epigastric burning/discomfort to boring/gnawing severe pain
Sometimes radiates towards back
Can be acute or chronic
Can be better or worse w/food
Sometimes emesis, which can be frank blood or 'coffee grounds' (blood altered by acid)
Stools turn black/dark (melena)
With ZE, recurrent/progressive ulcers that are unexplained, diarrhea
Physical Exam Findings
Can have tachycardia, hypotension, and ill appearance - depending on volume of blood lost
Sometimes epigastic pain on palpation
Rectal exam often w/black stool, guaiac +
Search for stigmata of liver disease (jaundice, ascites, edema, splenomegaly, etc) to assess risk for varices/portal gastropathy--> usually causes painless and profound upper GI bleeding assoc w/portal htn