General

Question 1

What factors must you take into account when assessing the severity of an upper GI bleed?

Answer 1

1. Young people tend to compensate and then crash hard
2. Diabetics have poor autonomic response
3. People on B-blockers can give you a false reassurance of pulse

Question 2

What should AF with abdominal pain always make you thing of?

Answer 2

Mesenteric ischaemia

Question 3

Acute mesenteric ischaemia?
What are the various causes and which patients do these occur in?
Classical presentation triad?
Tests?
Treatment?

Answer 3

Superior mesenteric
- thrombosis
- embolism from AF
Mesenteric vein thrombosis - more common in younger patients in a hypercoagulable state
Non-occlsuive - occurs in low flow states e.g. post cardiac surgery
1. Acute severe abdominal pain
2. No abdominal signs
3. Rapid hypovolaemia –> shock
Pain out of proportion to normal clinical findings
If non-viable, then resect, otherwise resuscitation with fluid, antibiotics and heparin

Question 4

Chronic mesenteric ischaemia
Classic triad and other symptoms?
What is often in the history?
Treatment?

Answer 4

Aka intestinal angina
1. Severe, colicky, post prandial abdo pain
2. Low weight
3. Upper abdo bruit
+/- PR bleeding, malabsorption, N&V
Often patient has a history of vascular disease
Surgery should be considered due to the ongoing risk of infarction; percutaneous transluminal angioplasty and stent insertion is replacing revascularisation