Acute GI bleeds Flashcards
We divide GI bleeds into upper and lower, what do we use as the boundary?
The ligament of treitz
Which connects the stomach to the junction of duodenum/jejunum
How does an upper GI bleed present?
Depends on the location
- Haematemesis
- Melaena
- Elevated urea
- Often associated with dyspepsia, reflux & epigastric pain
What causes elevated urea in a GI bleed?
partially digested blood
- > Ammonia
- > absorbed and broken down to urea
Whats the most common cause of upper GI bleeding?
Peptic Ulcer Disease, they can occur in any part of the upper GI tract
Duodenal Ulcers are the most common cause of Upper GI bleeds
Only tend to bleed when theres abnormal clotting
List some other causes of upper GI bleeds?
Oesophagus:
Varices - Mallory Weiss Tear - Malignancy
Stomach:
Gastric Varices - Malignancy - Dieulafoy - Angiodysplasia
Duodenum:
Angiodysplasia
What is angiodysplasia
A small vascular malformation of the gut
Associated with chronic cardiovascular disorders, mainly valvular abnormalities/replacements.
How does a peptic ulcer present?
- Dyspepsia
- Weight loss
- Collapse
- Low urine output
- Large volume Melaena
- Haematemesis
- Nausea/vomiting
What are hte risk factors for peptic ulcer disease?
- NSAIDs/Steroids/Anti-coagulants/Anti-platelets
- Alcohol & Smoking
- Past history of liver disease
- Family history of peptic ulcers or H pylori infection
How does a peptic ulcer arise?
An imbalance of damaging forces against defensive forces of the gut wall, either fue to increased damage or impaired defenses:
- H Pylori infection, NSAID, Aspirin, cigarettes, alcohol, gastric hyperacidity, gastric reflux
- Ischaemia, shock, delayed gastric emptying, host factors
What could cause excess gastric acid leading to a peptic ulcer?
Zollinger-Ellis Syndrome
Which is a gastrin-secreting pancreatic tumour
When would a case of gastritis or duodenitis or oesophagitis be likely to bleed?
IF theres impaired coagulation:
- Medical Conditions
- Anti-coagulants
- Anti-platelets
What the common causes of oesophagitis?
- Reflux
- Hiatus Hernia
- Alcohol
- Biphosphonates
- Systemic Illness
What tends to cause oesophageal varices and when are they most likely to lead to life-threatening bleeding?
Portal hypertension which is usually due to liver cirrhosis.
A sudden rise in portal pressure such as an infection or drug use can lead to severe bleeding
What is a mallory-weiss teat and how do we treat it?
A linear tear at the gastroesophageal junction, it usually follows a period of retching or vomiting
Most heal spontaneously but 10% require endoscopic treatment
What is diuelafoys lesion?
A submucosal arteriole becomes large and tortuous before eroding through the mucosa and bleeding into the gut
Most commonly in the gastric fundus