acute upper gastrointestinal bleeding Flashcards
most common causes of upper GI bleed
oesophageal varies or peptic ulcer disease
Sx of upper gi bleed
haematemesis
the most common presenting feature
often bright red but may sometimes be described as ‘coffee gound’
melena
the passage of altered blood per rectum
typically black and ‘tarry’
a raised urea may be seen due to the ‘protein meal’ of the blood
features associated with a particular diagnosis e,g,
oesophageal varices: stigmata of chronic liver disease
peptic ulcer disease: abdominal pain
oesophageal varices Sx
Usually a large volume of fresh blood. Swallowed blood may cause melena
oesphagitits sx
Small volume of fresh blood, often streaking vomit
cancer sx
Usually small volume of blood, except as a preterminal event with erosion of major vessels. Often associated symptoms of dysphagia and constitutional symptoms such as weight loss. May be recurrent until malignancy managed.
what is a mallory Weiss tear
Typically brisk small to moderate volume of bright red blood following a bout of repeated vomiting
gastric ulcer sx
small low volume bleeds - iron deficiency anemia
diffuse erosive gastritis
requires underlying cause such as recetrn NSAID use
duodenal ulcers may erode what artery
gastrodudenal artery
epogastric uncomfortable
melena
haematemesis
dudodenal ulcer occurs several Horus after eating
a Aorto-enteric fistula is a rare cause of an upper GI bleed which is found ij patients with
previous abdominal aortic aneurysm surgery
management of non vatical bleeding
endoscopy before PPI
management of varicella bleed
terlipressin and prophylactic antibiotics should be given to patients at presentation (i.e. before endoscopy)
band ligation should be used for oesophageal varices and injections of N-butyl-2-cyanoacrylate for patients with gastric varices
transjugular intrahepatic portosystemic shunts (TIPS) should be offered if bleeding from varices is not controlled with the above measures
