46 - Acute hemorrhage (UGIB) Flashcards
The relevant organs when talking about UGIB are: (3)
esophagus
stomach
duodenum
Esophageal bleeding can be caused by ___ (__%) or ___ (___%)
varices
20-30
esophagitis
5-10
Esophagitis can be caused by: (4)
chronic GERD
infections
radiation
IBD
How do we usually treat esophagitis? ___. We can also, in rare cases use ___ with ___ treatment
PPI
endoscopy
thermal/electrocoagulation
Gastric bleeding is usually caused by ___ (__%).
PUD
30-40
What are the most common reasons for gastric bleeding? (6)
PUD malignancy stress gastritis Mallory Weiss Dieulafoy's lesion
Gastric bleeding due to malignancy is usually characterized by __ bleeding, beside in the case of ___- where ___ bleeding is also common and surgery should be considered
chronic
GIST
acute
The following patients should not be treated with PPI due to risk for stress gastritis: (4)
ICU patient
septic shock
sepsis
burn (Curling ulcers)
Mallory Weiss bleeding is an ___ bleeding from the mucosa and submucosa of the ___, caused by repetitive ___- common in alcohol abuse
arterial
esophagogastric junction (GEJ)
vomiting
___ % of Mallory Weiss bleeding will resolve ___ and the mucosa heal within __ hours
90
spontaneously
72
How would you treat severe Mallory Weiss bleeding? (4)
endoscopy + epinephrine/coagulation
angiography embolization
surgery + suturing
What treatment is C/I in Mallory Weiss bleeding?
Blakemore tube
What are the common etiologies for PUD? (2)
H. Pylori
NSAID
Gastric ulcers tend to ___ more, but duodenum ulcers are more ___
bleed
common
Bleeding gastric ulcers -> damage to the ____ artery
left gastric (originating from the celiac artery)
Bleeding duodenum ulcers -> damage to the ____ artery
gastroduodenal artery (originating common hepatic artery)
The clinical presentation of PUD will include __ pain relived post ___ or after taking ___
epigastric
prandial
PPI
Other clinical presentation of PUD include: (4)
dyspepsia
nausea
vomiting
bleeding
Which criteria is used to assess the risk for rebleeding in PUD?
Forrest classification
Name the different classes of the Forrest classification: (6)
Ia - active pulsatile bleeding (high) Ib - active, non pulsatile bleeding (high) IIa - nonbleeding visible vessel (high) IIb - adherent clot (intermediate) IIc - ulcer with black spot (low) III - clean nonbleeding ulcer bed (low)
Curative endoscopy is recommended in Forrest > ___
IIc (IIb-Ia)
What other criteria do we use to decide if curative endoscopy is needed? (4)
shock
low Hgb
ulcer >2 cm
gastric ulcer
What are the common treatment procedures for PUD? (6)
PPI (IV) H. Pylori eradication cessation of ulcerogenic drugs (NSAID/SSRI/steroids) curative endoscopy curative angiography surgery
Curative endoscopy include either injecting ___ to the base of the ulcer, ___ of the bleeding vessel, or placing ___
injecting adrenaline to the base of the ulcer
ablation
hemoclip
In order to rule out malignancy, the PU should be examined with endoscopy ___ weeks post treatment . If the the ulcer is still there, we should obtain ___
4
biopsy
Varices bleeding is the leading mortality cause in ___ patients (__%)
cirrhosis
50
___ of patients with cirrhosis will develop portal HTN, ___% will develop varices, ___% of them will bleed.
2/3
30
30
What is the treatment procedure for varices bleeding? (5)
resuscitation Abx octreotide (somatostatin) curative endoscopy (X2) -sclerotherapy/band ligation Blakemore tube
What are the 5 ways to achieve a definitive treatment for esophageal treatment?
Drugs (BB + PPI + ligation) TIPS portosystemic shunts non shunts operation liver transplantation
TIPS=___
Transjugular-Intrahepatic-Portosystemic-Shunt
What do we do when performing TIPS?
connecting the hepatic vein with the portal vein using stent - bypassing the liver
What are the C/I for TIPS? (4)
HF
polycystic liver
encephalopathy
portal vein thrombosis
