GI Perforation/Bleeding

Question 1

What are common differentials for upper GI bleeds?

Answer 1

PUD
Oesophageal Varices
Oesophagitis
Mallory-weiss tear

Question 2

What is a Mallory-Weiss tear?

Answer 2

Tear of the tissue in the lower oesophagus

Caused by violent coughing or vomiting

Question 3

What is Boerhaave syndrome?

Answer 3

Spontaneous oesophageal perforation

Question 4

What causes boerhaave’s syndrome?

Answer 4

Repeated episodes of vomiting

Question 5

Where usually is the rupture in Boerhaave’s?

Answer 5

Distally site LHS

Question 6

What are the presenting features of Boerhaave’s?

Answer 6

Sudden onset chest pain
Severe vomiting
Subcut emphysema may be observed on the chest wall

Question 7

How is Boerhaave’s diagnosed?

Answer 7

CT contrast swallow

Question 8

What is the treatment for Boerhaave’s?

Answer 8

Thoracotoomy and lavage if within 12 hours

OR
T-tube insertion to create fistula between oesophagus and skin

Question 9

What is acute treatment for a variceal haemorrhage?

Answer 9

A-E
Terlipressin - vasoactive agent
IV ABs

Question 10

What is the prophylactive treatment for a variceal haemorrhage?

Answer 10

Propanolol

Endoscopic variceal band ligation

Question 11

What PPI should be prescribed in suspected Upper GI bleed prior to endoscopy?

Answer 11

Nothing prior to endoscopy

Question 12

How do you differentiate between upper and lower GI bleeds?

Answer 12

High Urea in upper