Acute Gastrointestinal Bleeding: Upper GI bleeding Flashcards
Where does Upper Gi Bleeding originate from
Oesophagus
Stomach
Duodenum
(Proximal to ligament trietz)
Where does Lower GI bleeding originate from
Bleeding distal to duodenum
(distal ligament of Treietz
What is the presentation of Upper GI bleeding
Haematemesis
Melaena
Elevated Urea
dyspepsia, reflux,
epigastric pain
What GI bleeding is associated with NSAIDS
Upper GI bleeding
What GI bleed is more common in older age
Lower GI bleeding
What is the presentation of lower GI bleeding
Fresh blood/clots
Magenta stools
Normal urea
Typically painless
What are two problems that after all areas of upper GI tract causing GI bleeding
Ulcers
Oesophagitis/duodenaitis/gastritis
What are 4 causes of Upper GI bleeding in the oesophagus
Oesophageal varices
Mallory Weiss Tear
Oesophageal malignancy
Ulcer
What are the 5 causes of Upper GI bleeding in the stomach
Gastric varices
Gastric malignancy (may be under an ulcer)
Dieulafoy
Angiodysplasia
Lymphoma of the stomach
Ulcer
What is the 2 causes of upper Gi bleed from the duodenum
Angiodysplasia
Ulcer
What is the most common cause of GI bleed
Peptic ulcer
What is the aetiology of peptic ulcer
Liver disease Drugs - NSAIDS Alcohol Smoking H.Pylor Systemic - stress ulcers
What is the pathology of a peptic ulcer
Increase damage or impaired defences results in
Necrosis debris,
Non specific acute inflammation
granulation tissue and fibrosis
What is the pathology of H.Pylori result causing a peptic ulcer
produces enzyme urease, which breakdown product ammonia causes a buffer of gastric acid, therefore increasing acid production
Increasing the damage to the surface
What is the pathology of NSAIDS/Aspirin causing a peptic ulcer
Prostaglandin production reduced mucus and bicarbonate excretion therefore reducing physical defence
What is Zollinger - Ellison syndrome and its affect on peptic ulcers
gastrin-secreting pancreatic tumour
that result in recurrent poor healing duodenal ulcers
What can gastric ulcers potentially cover
Gastric carcinoma
What is the causes of gastritis and duodentits
Due to impaired coagulation:
Medical condition
Anti-coagulants
Anti-Platlets
What is the causes of oesophagitis
Reflux oesophagitis
Hiatus hernia
Alcohol
Bisphosphonates
Systemic illness
What anti-platelet medication may give you significant bleeding
Clopidogrel
Ticagrelor
What anti-coagulation medication may give you significant bleeding
warfarin, rivaroxaban, apixaban, dabigatran
What is the pathology of varices
LIver cirrhosis results in portal hypertension ,
The increased portal pressure, abnormally dilate collateral vessels and lead to life threatening bleeding
Where is the 3 locations of varices can occur in the GI tract
Oesophagus
Gastric renal and splenic
What is the symptoms of oesophageal cancer
Dysphagia
Weightloss
“ooze”
