Stress ulcer disease in the burned patient

Pruitt, Basil A.; Goodwin, Cleon W.

doi:10.1007/bf01658293

Cited by 48 publications

(13 citation statements)

References 33 publications

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“…Gastric ulcers are small, sharply demarcated and superficial. Duodenal ulcers tend to be single, deeper and more prone to perforate [2,3,4,5]. Ninety years after Curling’s report, Cushing [6] identified trauma or surgery of the central nervous system as a stimulating trigger for a specific form of stress ulcer that bears his name.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic Ulcers after Great East Japan Earthquake and Tsunami: Features of Post-Disaster Hemorrhagic Ulcers

Kanno¹,

Iijima²,

Abe³

et al. 2013

Digestion

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Background: We investigated the characteristic features and treatment of hemorrhagic peptic ulcers after the Great East Japan Earthquake, which occurred on 11 March 2011. Methods: Clinical data of patients with hemorrhagic peptic ulcers were retrospectively collected during the 3 months after the earthquake from seven major hospitals in the middle of the stricken area, and were compared with those during the same period of the previous year. Results: After the earthquake, the number of hemorrhagic ulcers increased 2.2 fold as compared with the previous year, and gastric ulcers were significantly more frequent compared with duodenal ulcers (p <0.05) and more often presented multiple forms (p <0.05). Nonetheless, the proportion of re-bleeding cases after hemostasis treatment (8% in 2010 vs. 5% in 2011) or total mortality rate (2.5% in 2010 vs. 1.2% in 2011) was rather lower after the earthquake compared with that of the previous year. Conclusion: We clarified that post-disaster hemorrhagic ulcers existed frequently in the stomach, often as multiple ulcers at the same time. The Great East Japan Earthquake and Tsunami caused many cases of hemorrhagic ulcer. However, because of the high success rate of endoscopic hemostasis, the mortality remained as low as in the previous year. Our present study provides important information for large-scale disasters which can occur anywhere.

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Section: Discussionmentioning

confidence: 99%

Hemorrhagic Ulcers after Great East Japan Earthquake and Tsunami: Features of Post-Disaster Hemorrhagic Ulcers

Kanno¹,

Iijima²,

Abe³

et al. 2013

Digestion

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“…Repeated studies have shown the effectiveness of antacids in preventing this lesion [52,53]. The early reports of the ineffectiveness of H2 recep-' tor antagonists may be attributed to inadequate dosage, although there are still conflicting reports about their efficacy [54,55]. Prostaglandins have not been demonstrated to be an effective prophylaxis against hemorrhagic gastritis [56].…”

Section: Medical Therapymentioning

confidence: 96%

Acute Gastrointestinal Bleeding

Schaffner

1986

J Intensive Care Med

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A greater understanding of the pathophysiology of gastrointestinal bleeding has been accompanied by a rapid advancement in therapeutic technology. Newer endoscopic and radiologic techniques are being tested to determine their appropriate uses, but pharmacologic therapy has yet to be proved beneficial. A discussion of the newer as well as some traditional therapies is presented.The approach to treating the patient with gastrointestinal (GI) bleeding is changing with newer diagnostic techniques, pharmacotherapeutics, and technologic advances. Despite recent progress, GI bleeding is still a major cause of morbidity and mortality. As many as 10% of patients admitted to hospitals with GI bleeding die from the bleeding or its complications. It is hoped that some of the more recent additions to the therapeutic armamentarium will reduce this high mortality rate. The benefits of traditional methods of treatment as well as newer modes of therapy are discussed. AssessmentMonitoring the patient's vital signs is the most important means of assessing the degree of bleeding. The rate of bleeding as well as the volume of blood loss determines changes in vital signs. Patients may . lose up to 10 to 15 % of their blood volume without a change in pulse or blood pressure. However, with extremely rapid bleeding, a loss of as little as 10% of blood volume can result in clinical signs of shock. Generally, orthostatic changes in pulse and blood pressure occur with a 15 to 20% loss of circulating volume. Shock is almost invariably present when the patient loses more than 30% of the blood volume.When hemodynamic parameters are available, the first sign of bleeding is an increase in the pulmonary artery pressure [1]. Central venous pres-_ sure, pulmonary capillary wedge pressure, and arterial pressure were less reliable measures of blood loss in patients studied before, during, and after hemorrhage. When large volumes of replacement fluids are needed to stabilize the patient, central monitoring is required. Patients who are hemodynamically unstable after initial fluid replacement should also be monitored with at least a central venous catheter. Although a single measurement of central venous pressure may not be helpful, continuous readings can help gauge fluid replacement.

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“…Gastric antral or duodenal lesions did not occur without concomitant ulcers or erosions in the gastric fundus [16]. Simultaneous gastric and duodenal stress ulcers occur in 15% of burn patients [35]. Autopsy series in burn patients showed that isolated duodenal stress ulcers can occur [11,17,21,22].…”

Section: Clinical Presentation and Coursementioning

confidence: 99%

“…Stress ulcers are most often multiple and located in the gastric fundus or proximal stomach [28,34,35]. One endoscopic survey of burn patients noted mucosal lesions were predominant in the gastric fundus and body.…”

Section: Clinical Presentation and Coursementioning

confidence: 99%

Stress Ulcer Syndrome

Zuckerman

Cort

Shuman

1988

J Intensive Care Med

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MO 63110.Stress ulcer syndrome refers to gastroduodenal erosions or ulcers that develop acutely in relation to major physiological stress, usually manifested clinically as upper gastrointestinal (UGI) bleeding. These lesions occur most often in the gastric fundus. Endoscopy has shown gastroduodenal mucosal lesions in 75 to 100% of intensive care unit (ICU) patients within 72 hours of admission. Patients at high risk for stress ulcer include those with large body surface area burns, intracranial lesions associated with coma, fulminant hepatic failure, sepsis, and trauma and abdominal, cardiovascular, and thoracic surgery patients. Also considered high risk are ICU patients with superimposed complications such as shock, mechanical ventilation for more than 3 days, coagulopathy, jaundice, and sepsis. Approximately 15% of ICU patients will experience UGI bleeding from stress ulcer. Patients bleeding from stress ulcer have an overall mortality rate approaching 65% compared with 9 to 22% mortality in patients without stress ulcer. When stratified according to occult blood loss versus clinically significant bleeding, mortality can be as high as 90% in patients overtly bleeding; 30% of deaths are directly related to bleeding. Both antacids and H 2 receptor antagonists are effective in prophylaxis for stress ulcer bleeding.Gastrointestinal bleeding is a major problem in intensive care medicine, and upper gastrointestinal (UGI) hemorrhage may occur in 10% or more of intensive care unit (ICU) patients [1]. Bleeding representing the usual spectrum of UGI mucosal lesions can be responsible for admission to the ICU, but bleeding can also be a secondary complication that occurs during the ICU stay. The latter has been referred to as the clinical syndrome of &dquo;stress ulcer.&dquo; Stress ulcers are acutely formed defects in the gastroduodenal mucosa that develop in a critically ill patient with a severe physiological derangement.

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Stress ulcer disease in the burned patient

Cited by 48 publications

References 33 publications

Hemorrhagic Ulcers after Great East Japan Earthquake and Tsunami: Features of Post-Disaster Hemorrhagic Ulcers

Hemorrhagic Ulcers after Great East Japan Earthquake and Tsunami: Features of Post-Disaster Hemorrhagic Ulcers

Acute Gastrointestinal Bleeding

Stress Ulcer Syndrome

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