GI Bleed

Question 1

How are upper GI Bleeds Caused?

Answer 1

Peptic ulcers, erosive gastritis, Mallory Weiss tears (d/t violent coughing), esophageal varices

Question 2

How does Upper GI bleeds manifested?

Answer 2

Syncope, angina, dyspnea, increased weakness, fatigue, orthostatic changes

Question 3

What is Peptic Ulcer Disease?

Answer 3

PUD in the portion of the Gi tract exposed to acid pepsin secretions (gastric + proximal duodenum)

Question 4

What are the risk factors for PUD?

Answer 4

H.Pylori infection, NSAIDS (disrupts mucosal defense barrier) – susceptible to damage from gastric acid and peptin

Question 5

What are the Classification of PUD?

Answer 5

Depth - how deeply penetrated
Erosion (superficial)
Either acute (muscosa + submucosa)
or Chronic (perforated)

Question 6

What are the manifestation of PUD?

Answer 6

Depends on the locations
Pain (increased abd epigastric area)
N/v, anorexia, weight

If pyloric canal pain occurs (bloating, n/v) after eating
Blooding hidden or gross (hematemesis, melena, hematochezia)

Question 7

What are the Diagnosis of PUD

Answer 7

Endoscopy
Or H.Pylori investigation

Question 8

What are the treatments for PUD?

Answer 8

General: antibiotics, antacids, PPI
Often heals spontaneously not acid suppressive therapy accelerates healing

Question 9

[Non Ulcer Etiologies] What Is Stress Related Muscosal Disease?

Answer 9

Acute form of PUD
2 types: superficial, diffuse erosion and stress ulcer (deep disease ulcers)

Question 10

[Non Ulcer Etiologies] What is Acute Erosive or Hemorrhagic Gastritis?

Answer 10

Inflammation of stomach that leads to upper GI bleed
Shows as hematemesis, bloody aspirate

Question 11

[Non Ulcer Etiologies] What is Esophageal and Gastric Varices?

Answer 11

Upper GI blood associated with cirrhosis (bleeding of the liver without warning), partial HTN or partial or splenic vein thrombosis

Question 12

[Non Ulcer Etiologies] What is Mallory-Weiss Tears?

Answer 12

Small laceration in mucus due to coughing and extreme vomiting
High risk patients may have a history of alcohol abuse

Question 13

[Non Ulcer Etiologies] What is Arteriovenous Malformation?

Answer 13

Small abnormal mucosal or submucosal blood vessel with tendency to bleed
Occurs in upper or lower GI tract, based on genetics

Question 14

What are the causes of Acute Lower GI Bleed?

Answer 14

Less common and less severe than Upper GI bleed

Causes: Diverticulosis, arteriovenous malformation, and irritable bowel disease
(Crohn’s and Ulcerative Colitis)