Gl Bleeding Flashcards
What is the Ligament of Treitz?
An anatomical structure separating the upper GI and lower GI.
What are the components of the upper GI tract?
- Oesophagus
- Stomach
- Upper duodenum
What is the most common cause of upper GI bleeding?
NSAIDs block COX-1 pathway that reduces prostaglandin synthesis which stimulates gastric mucus and bicarbonate secretion or gastrinoma.
What is Haematemesis?
Vomiting blood.
What is melena?
Black sticky and tarry appearing stools.
Why is upper GI bleeding typically darker?
Because blood is oxidised by the HCL.
What are common causes of upper GI bleeds?
- Gastric ulcers
- Duodenal ulcers
- Oesophageal varices
What is the cause of oesophageal varices?
Oesophageal varices typically occur due tp portal hypertension causing backflow and resulting in variceal bleeding. This is associated with liver cirrhosis, but can occur with severe right sided heart failure, constrictive pericarditis, Budd-Chiari syndrome and a massive splenomegaly. The portal venous system has no valves so increased resistance with the right side of the heart, liver causes retrograde flow and tortuous dilated veins. A major risk factor is active alcohol consumption.
What is the clinical presentation of oesophageal varices?
Haematemesis, melena or haematochezia, jaundice, anorexia, splenomegaly. The peripheral stigmata of alcohol abuse may be present. Thrombocytopenia, anaemia and elevated ALT, BUN and AST are indicators. Hepatic vein pressure gradient is the gold standard for diagnosis it clinically signficant portal hypertension
What is the peripheral stigmata of alcohol abuse?
The peripheral stigmata of alcohol abuse may be present, which is palmar erythema, gynaecomastia, testicular atrophy and spider angiomata.
What condition typically causes oesophageal varices?
Portal hypertension.
What is a major risk factor for oesophageal varices?
Active alcohol consumption.
What clinical presentations are associated with oesophageal varices?
- Haematemesis
- Melena
- Jaundice
- Anorexia
- Splenomegaly
What is the clinical presentation of oesophageal cancer?
Patients present with progressive dysphagia, affecting solids and liquids as tumour enlarges, with unintentional weight loss and odynophagia (painful swallowing). Chest pain may develop and hoarseness of voice cervical and supraclavicular Lymphadenopathy can indicate metastatic spread.
What is the common site of metastasis?
Frequent sites of metastasis are the liver, lungs and lymph nodes and peritoneum.
What is treatment of oesophageal cancer?
Treatment is endoscopic resection or ablation for superficial disease. For lymph node involvement, resection of oesophagus and lymph nodes or chemo radiation.
What is a Mallory Weiss tear?
A longitudinal tear in the oesophageal wall associated with vomiting/retching.
How does Mallory Weiss syndrome present?/
Patients are typically asymptomatic apart from Haematemesis which can be blood streaked mucus to massive bright red blood volumes. With severe bleeding, melena, dizziness and syncope may occur. In the presence of GERD, epigastric pain may be present.
How is Mallory Weiss syndrome treated?
It is treated with PPI inhibitor, H2 blockers to decrease gastric acidity. They may gave dilated tortuous vessels around the lower oesophagus, which is a complication of portal hypertension.
What is the cause of gastritis?
NSAIDs, alcohol, Cushing’s ulcers or H.pylori infection
What is peptic ulcer disease commonly associated with?
- H.pylori infection
- Use of NSAIDs
How is helicobacter pylori infection transmitted?
H.pylori infection which is transmitted via direct contact with saliva, vomit or stool, through contaimined food or water. It produces bacterial urease that counteracts the effects of gastric acid and the toxins released cause damage to the mucosa lining
What does H.pylori infection produce that counteracts gastric acid?
Bacterial urease.
What are the protective factors for oesophageal adenocarcionoma?
Protective factors are fruit and veg intake, PPIs, NSAIDs and high fibres diet. Treatment is typically with resection.