L23: GI Bleed - PUD Flashcards
List 3 common causes of peptic ulcer disease
- H. pylori
- NSAID use
- gastrinoma (ZE)
List some of the symptoms of peptic ulcer disease
- epigastric pain (dull, gnawing pain)
- waterbrash = acid reflux into mouth
- heartburn = acid reflux into oesophagus
- anaemia
- weight loss
- early satiety
- malaena/haematemesis
What are some complications of peptic ulcer disease?
- gastric outlet obstruction
- penetration + fistulation
- perforation (+ peritonitis)
What is malaena?
- black, tarry, foul-smelling stool
- containing blood from upper GIT
What is haematemesis?
bright, fresh blood being vomited out
If blood from haematemesis is bright red, where is it probably coming from?
oesophagus
If a patient has “coffee ground vomit”, where is the blood probably coming from?
stomach
What is the Blatchford Score?
helps identify which patients with upper GI bleeding may be safely discharged from the emergency room
- can be used for PUD which causes bleeding
- determines severity of bleed
Why is an erect chest x-ray done when investigating peptic ulcer disease?
free air under diaphragm present when there is a perforated peptic ulcer
What 2 tests can be done to check if H. pylori is present in peptic ulcer disease?
- CLO Test
2. Urease Breath Test
List 3 things that can give a false positive in the detection of H. pylori through a CLO test?
- Long-Term PPI Use
- Antibiotic Use
- Recent GI Bleed
H. pylori peptic ulcer disease increases the risk of which 2 cancers?
- Gastric Adenocarcinoma
2. Gastric MALToma
What is the main treatment for symptomatic NON-BLEEDING peptic ulcers?
Proton Pump Inhibitors
PPIs are the first-line treatment for symptomatic NON-BLEEDING peptic ulcers. If PPIs are contraindicated, what may be given?
H2 Antagonists
What are the side effects of PPIs?
hyponatraemia risk of C. difficile infection hypomagnesemia risk of osteoporotic fractures pneumonia vitamin B12 deficiency
What is Triple Therapy Eradication used for?
H. pylori peptic ulcer disease
What is Triple Therapy Eradication treatment?
- used for H. pylori peptic ulcer disease
- 1 PPI
- 2 Antibiotics
- used for 14 days
What is an OGD? What is it used for?
oesophago-gastro-duodenoscopy
- used to investigate PUD and GI bleeding
What is a highly selective vagotomy? What is it used for?
- last resort treatment for PUD
- inhibits vagus nerve to stop stomach from producing too much acid
What is the clinical + laboratory features of Zollinger-Ellison syndrome?
- duodenal ulcers (no H. pylori + failure to heal w/ PPI or H2 antagonists)
- diarrhea
- hypergastraemia
- hypercalcaemia
- endocrinopathy
Which ligament splits upper GI and lower GI bleeding?
Ligament of Treitz
What is haematochezia?
- indicates a lower GI bleed
- bright fresh blood from rectum
What are the 2 main types of upper GI bleeding?
- Non-Variceal
2. Variceal
What is haemoptysis?
vomited or coughed up blood
What is epistaxis?
blood coming from the nose or nasopharynx
If there is an upper GI bleeding, weight loss and dysphagia what is the most likely diagnosis?
carcinoma
If there is upper GI bleeding after forceful vomiting what is the most likely diagnosis?
Mallory-Weiss tear
If there is upper GI bleeding in someone who drinks a lot of alcohol what is the most likely diagnosis?
variceal-related upper GI bleed
What does pallor of the conjunctiva suggest?
anaemia
What does pallor of the palmar creases suggest?
anaemia
If a patient experiences epigastric pain that is worsened by food, what type of peptic ulcer do they have?
gastric ulcer
If a patient experiences epigastric pain that is worsened when hungry, what type of peptic ulcer do they have?
duodenal ulcer
Most of upper GI bleeds are due to a peptic ulcer. In this regard, is a duodenal or gastric ulcer more likely to bleed?
duodenal ulcer
What is the Rockall Score used for? What do the scores mean?
- to determine the severity of GI bleeding
- done after endoscopy is completed
< 3 = good prognosis
> 8 = high mortality
What is the treatment for an EMERGENCY variceal upper GI bleed?
Terlipression
- also blood transfusion if Hb < 8g/dL
- do an endoscopy with variceal banding
What is the treatment for an EMERGENCY NON-variceal upper GI bleed?
IV PPI
- also blood transfusion if Hb < 8g/dL
- do an OGD to find source of bleeding
How does Terlipression work and what is it used for?
- used for VARICEAL upper GI bleed
- narrows blood vessels to stop bleeding
