3. Gastrointestinal bleeding

Question 1

Clinical assessment of upper gastrointestinal bleeding ?

Answer 1

• Hematemesis.
• Syncope. (due to hypotension)
• Symptoms of anemia suggest chronic bleeding.
• Melaena: black, tarry stools.

Question 2

Dieulafoy’s lesion?

Answer 2

• Upper GI bleeding.
• A condition of profuse bleeding from an abnormal vessel situated in the gastric mucosa and not associated with ulceration.
• Bleeding is treated initially by injection sclerotherapy, but may require open gastrotomy and oversewing of bleeding point.

Question 3

Oesophageal varices?

Answer 3

• Upper GI bleeding.
• Chronic liver disease.
• Control of bleeding ( Tamponade, Endoscopic banding or injection of sclerotherapy.

Question 4

Sengstaken-blakemore tube ?

Answer 4

• The tube is inserted in same way as normal nosogastric tube, used occasionally in the management of upper gastrointestinal hemorrhage due to esophageal varices

Question 5

Mallory-Weiss syndrome/tear ?

Answer 5

• Is a tear in the mucosal layer at the junction of the esophagus and stomach.
• Usually caused by severe retching, coughing, or vomiting.

Question 6

Barrett’s esophagus?

Answer 6

• Is a pre-malignant glandular metaplasia of lower esophagus.
• The normal squamous lining is replaced by columnar mucosa composed of a cellular mosaic containing areas of intestinal metaplasia.

Question 7

Aortoenteric fistulas ?

Answer 7

• Upper GI bleeding.
• A connection between the aorta and small intestine.
• Treatment by open surgery or endovascular exclusion and antibiotics.

Question 8

Meckel’s diverticulum ?

Answer 8

• The most common congenital anomaly of gastrointestinal tract.
• Asymptomatic.

Question 9

Angiodysplasia ?

Answer 9

• Lower GI bleeding.
• Is a disease of elderly.
• Treatment: endoscopic thermal ablation/resection of affected bowel..

Question 10

Ischaemic colitis ?

Answer 10

• Due to occlusion of the inferior mesenteric artery.
• Presents with abdominal colic and rectal bleeding.
• Resection is required only in the presence of peritonitis.

Question 11

Haemorrhoids ?

Answer 11

• Bleeding is bright red and occurs during or after defecation.
• Diagnosis: proctoscopy / colonoscopy.

Question 12

Anal fissure ?

Answer 12

• Fresh rectal bleeding and anal pain occur during defecation.

Question 13

Kehr’s sign ?

Answer 13

is pain referred to the left shoulder due to irritation of the left hemidiaphragm. Often seen with splenic rupture.

Question 14

Murphy’s sign ?

Answer 14

Is seen in cholecystitis.