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. en 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’sulcer occurs when
burn injury is more than
35%.
• It is observedin 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
frequentlyperforates.
• It can occur in oesophagus
and duodenumalso.
BLEEDINGPEPTICULCER
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
• Elderlyage, associated
systemicdiseases increase
the mortality.
• NSAIDs and H. pylori
infection,
• Coagulopathy, and
anticoagulant drugs
• Concomitant use of NSAID
& steroids increaserisk by
10-fold.
DUODENALULCER.
BLEEDINGDUODENAL
ULCER
• 10% common.
• Risk of bleeding in chronic
duodenal ulcer increases
to 35%if patienthas not
takenspecificanti
• Helicobacter pylori
therapyand PPI.

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

7. ↓
It is less severe, gradual and
most oftenwell-controlledby
conservative treatment.
↓
Bleeding fromerosionof
gastroduodenal arteryis
severe, torrential and almost
alwaysneeds earlysurgical
intervention.
CLINICALFEATURES
• Haematemesis &
melaena.
• Features of shock
• Pallor
• Tachycardia
• Sweating
• Hypotension
• Tachypnoea
• Dry tongue
• Cold periphery.
• Past history of chronic
DU may be present.

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

9. INVESTIGATION
• Estimationof serum
electrolytes
• Blood urea, Serum
creatinine,
• plateletcount
• To look for in endoscopy,
in bleeding ulcer
• Gastroscopy is
confirmative
• Coeliac angiogramto
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
• Plasma 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 givento the
stomachthrough Ryle’s
tube.
• Endoscopiccauterisation
of small vessel with either
gastroscopicbipolar
cauteryor throughLaser
• Sclerotherapy—
ethanolamine oleate,
distilledwater.
• 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
embolisationof
gastroduodenal artery.
• Haemoclips placement
over the bleeding point
endoscopically
• Surgery After
laparotomy, pyloric
channel and first part of
the duodenum
(gastroduodenum)
GASTRICULCERBLEEDING
DEFINITION
• It is similar to bleeding
DU.
• Bleeding may be either
fromthe ulcer bed or from
theerosionof gastric
vessels commonly but
occasionallysplenicvessels.

12. CLINICALFEATURES
• Severe haematemesis and
shock.
• Bleeding is much more
severe thanbleeding DU.
TREATMENT
• Surgery is the main
treatment
• After initial resuscitation,
blood transfusionand a trial
of conservative
management, laparotomy is
done
• Underrunning of the ulcer
bed ™
• Partial gastrectomywith
Billroth
• Vagotomy with
antrectomy ™
• Occasionally splenicvessel
ligation with splenectomy
may be required.

13. REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das

14. A
Special Thanks
To A Very
Special Doctor