Appendix F

 Algorithm of diagnosis and treatment

of bleeding ulcer

(obligatory)

 

Weakness, haematomesis, melena

 

 

Emergency endoscopy

 

 

Forrest I                          Forrest II                               Forrest III

 

 

                       Endoscopic haemostasis + conservative therapy

 

 

 

Evaluation of effect using clinical and endoscopic control

 

 

 

Forrest I                          Forrest II                          Forrest III

 

 

Absolute                       Relative                           Prolongation

indication                    indication                         of conservative                     for surgery                  for surgery                              therapy     

 

 

 

   Removal of all ulcer substrates is

                       necessary