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| ==Initial Laboratory Studies== | | ==Initial Laboratory Studies== |
| *Common laboratory findings include [[anemia]], [[coagulopathy]], and an elevated [[BUN-to-creatinine ratio]].<ref name="pmid26034359">{{cite journal |vauthors=Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N |title=Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding |journal=World J. Gastroenterol. |volume=21 |issue=20 |pages=6246–51 |year=2015 |pmid=26034359 |pmc=4445101 |doi=10.3748/wjg.v21.i20.6246 |url=}}</ref><ref name="pmid25567834">{{cite journal |vauthors=Owensby S, Taylor K, Wilkins T |title=Diagnosis and management of upper gastrointestinal bleeding in children |journal=J Am Board Fam Med |volume=28 |issue=1 |pages=134–45 |year=2015 |pmid=25567834 |doi=10.3122/jabfm.2015.01.140153 |url=}}</ref>
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| *The [[hematocrit]] level is used to identify the degree of [[blood loss]] and suggests the acuity or chronicity of [[blood loss]].<ref name="pmid17983811">{{cite journal |vauthors=Raju GS, Gerson L, Das A, Lewis B |title=American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding |journal=Gastroenterology |volume=133 |issue=5 |pages=1694–6 |year=2007 |pmid=17983811 |doi=10.1053/j.gastro.2007.06.008 |url=}}</ref><ref name="pmid23547576">{{cite journal |vauthors=Bull-Henry K, Al-Kawas FH |title=Evaluation of occult gastrointestinal bleeding |journal=Am Fam Physician |volume=87 |issue=6 |pages=430–6 |year=2013 |pmid=23547576 |doi= |url=}}</ref>
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| *Serial complete blood count ([[CBC]]) tests are important for monitoring the presence of ongoing [[blood loss]].
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| *Initial [[CBC]] may not fully reflect the actual degree of acute [[blood loss]].
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| *On [[peripheral blood smear]] prepared with [[Wright's stain|Wright-Giemsa stain]], normal [[erythrocytes]] are smaller than the nucleus of a [[Lymphocyte|normal lymphocyte]], and the central clear area should not be overly prominent.
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| **[[Iron-deficiency anemia]] is associated with chronic [[blood loss]], in which [[erythrocytes]] are smaller ([[microcytic]]) and appear lighter ([[hypochromic]]) than normal cells.
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| *Mild to moderate [[thrombocytopenia]] (>30 × 103/µL) does not usually result in spontaneous bleeding, although patients with a pre-existing lesion may bleed in the presence of even mild [[thrombocytopenia]].<ref name="pmid27588176">{{cite journal |vauthors=Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N |title=Low hemoglobin levels are associated with upper gastrointestinal bleeding |journal=Biomed Rep |volume=5 |issue=3 |pages=349–352 |year=2016 |pmid=27588176 |pmc=4998006 |doi=10.3892/br.2016.727 |url=}}</ref>
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| *[[Platelet count]] may rise in response to significant [[gastrointestinal bleeding]] and may fall with multiple [[blood transfusions]].
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| *Low [[ferritin]] level is the most specific test for [[Iron deficiency anemia|iron-deficiency anemia]]. This finding together with a low [[iron]] and high [[Total iron-binding capacity|TIBC]] levels are helpful in diagnosing [[Iron deficiency anemia|iron-deficiency]] anemia, a common complication of ongoing or significant UGIB.<ref name="pmid26034359">{{cite journal |vauthors=Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N |title=Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding |journal=World J. Gastroenterol. |volume=21 |issue=20 |pages=6246–51 |year=2015 |pmid=26034359 |pmc=4445101 |doi=10.3748/wjg.v21.i20.6246 |url=}}</ref>
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| *[[Blood urea nitrogen|BUN]] level may be elevated out of proportion to any increase in the [[creatinine]] level in patients with UGIB, secondary to breakdown of [[blood]] [[proteins]] to urea by intestinal [[bacteria]].<ref name="pmid22534226">{{cite journal |vauthors=Wilkins T, Khan N, Nabh A, Schade RR |title=Diagnosis and management of upper gastrointestinal bleeding |journal=Am Fam Physician |volume=85 |issue=5 |pages=469–76 |year=2012 |pmid=22534226 |doi= |url=}}</ref>
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| *There are no diagnostic laboratory findings associated with peptic ulcer disease. | | *There are no diagnostic laboratory findings associated with peptic ulcer disease. |
| | | *If there is the history of peptic ulcer disease then following laboratory test can be useful: |
| *If there is history of peptic ulcer disease then following laboratory test can be useful : | |
| *Complete blood count | | *Complete blood count |
| *Serum lipase and amylase | | *Serum lipase and amylase |
| *Iron studies | | *Iron studies |
| **
| | *Some patients with Peptic ulcer disease may have reduced serum ferritin, which is usually suggestive of bleeding which suggests mandatory endoscopy |
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| *Some patients with Peptic ulcer disease may have reduced serum ferritin , which is usually suggestive of bleeding which suggests mandatory endoscopy | |
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| ==References== | | ==References== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Guillermo Rodriguez Nava, M.D. [2] Manpreet Kaur, MD [3]
Overview
In patients with peptic ulcer who are unstable rapid assessment and resuscitation should be initiated even before diagnostic evaluation. Once hemodynamic stability is achieved, a proper clinical history, physical examination, and initial laboratory findings are crucial not only in determining the likely sources of bleeding but also in directing the appropriate intervention. In acute ulcer bleeding, initial hematocrit level measured will not accurately reflect the amount of blood loss. Laboratory findings of peptic ulcer bleeding include anemia, coagulopathy, and an elevated BUN-to-creatinine ratio.
Initial Laboratory Studies
- There are no diagnostic laboratory findings associated with peptic ulcer disease.
- If there is the history of peptic ulcer disease then following laboratory test can be useful:
- Complete blood count
- Serum lipase and amylase
- Iron studies
- Some patients with Peptic ulcer disease may have reduced serum ferritin, which is usually suggestive of bleeding which suggests mandatory endoscopy
References
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