Bleeding ulcer : A life threatening cause of anemia of acute blood loss
Bleeding ulcer in the stomach or the upper part of the intestine can cause severe blood loss resulting in life threatening anemia. Bleeding ulcer may develop quickly in some patients taking certain medications. Patients presenting with bleeding ulcers may or may not have the typical symptoms of stomach ulcer. Some patients may have pain the stomach but others only present with bleeding. Most patients with bleeding ulcer are very sick and unstable. Most bleeding ulcer patients are treated in ICU. I will describe some cases of patients with bleeding ulcer that I admitted to the hospital. Looking at real cases is a great way to learn how bleeding ulcer presents.
Bleeding ulcer : A 65 year old male with severe arthritis
Mr. K is a 65 year old retired high school teacher who has bad arthritis in his knees and his hips. He used to be very active and athletic when he was young but has been severely limited by joint pain in the last three years. He had tried several different medications in the past with only minimal relief.
Recently, his doctor changed his medication. After he started taking these new pills, he has felt somewhat weak. He occasionally has some burning sensation in his stomach after he takes the pill. He also feels sick to his stomach after meals. Despite these side effects he felt like the new pill was helping his arthritis pain and he continued to take it. After 10 days, he had an episode of severe stomach discomfort one night after his dinner. He said it felt more like burning, fullness and discomfort rather than actual pain. As his symptoms worsened, he became more nauseated. He also felt very weak and dizzy. He was so weak that he felt like he was going to faint. He called his son and they called the ambulance and took him to the hospital right away.
When he arrived in the ER, he was in a bad shape. His blood pressure was low and his heart was racing fast. They put an IV line and started to infuse him with IV fluids. His blood pressure improved after the fluid but his heart was still racing. He was still having some discomfort in his stomach. As they were planning to do more tests, he told the doctors that he had noticed somewhat unusual with bowel movement. He told them he had a black tarry stool the other night. As soon as he mentioned that, the ER doctor was immediately worried about a bleeding ulcer. He took a narrow tube, inserted it into his nose and pushed it all the way down to his stomach. He then infused some saline solution into his stomach to wash it. He then drew back some of the solution to see if it would show anything. The saline came back looking very bloody. The ER doctor made the diagnosis of possible bleeding ulcer and sent the patient to ICU.
In the ICU, I treated the patient after consulting with a specialist who specializes in conditions like bleeding ulcer in the gastrointestinal tract. He checked with blood count and he was anemic from the bleeding. We transfused a total of six units of blood. We started him on some strong medications that help to prevent further bleeding. After, his blood pressure became stable, they did an upper endoscopy. It is a thin long tube with camera that they pass down the mouth into the stomach to see what exactly is going on in the stomach. They found two separate patches of bleeding ulcer. The good news was that the areas of bleeding ulcer seemed stable. They did not find any actively bleeding artery. The medications had helped.
In this patient, the bleeding ulcer was caused by the arthritis medication. A class of medication very useful in treating arthritis and other painful condition called NSAIDs are known to cause bleeding ulcer in some patients. It is very hard to predict who might develop the bleeding ulcer. Once, a patient has developed bleeding ulcer after taking this class of medicine, they should not take those medications again. Common examples of NSAIDs that can cause bleeding ulcer are high dose Ibuprofen, high dose naproxen, indomethacin and several other medications in the same class.
I hope the story of Mr K helped you understand more about bleeding ulcer symptoms. Please check back soon as I will be uploading more real patient stories about different types of patients with diagnosis of bleeding ulcer.