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Inflammation block > Peptic ulcer disease/GI bleeding > Flashcards

Peptic ulcer disease/GI bleeding Flashcards

1
Q

What is melena

A
  • Dark black, tarry feces
  • Associated with upper GI bleeding.
  • The black color and characteristic strong odor are caused by hemoglobin in the blood being altered by digestive enzymes and intestinal bacteria.
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2
Q

What are the causes of UGI bleeding

A
  • Mallory-Weiss tear
  • Oesophagitis/gastritis
  • Oesophageal varices
  • Peptic ulcer
  • Malignancy
  • Drugs-NSAIDs, aspiring, anticoagulants, steroids
  • Angiodysplasia
  • Aorto-enteric fistula (low survival rate)
  • Erosive disease
  • Neoplasm
  • Some have no obvious cause
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3
Q

What is a Mallory-Weiss tear?

A
  • Between the oesophago-gastric junction, often down into the fundus of the stomach
  • Often presents in pts who have been vomiting/retching for a long time then they’ll vomit up some blood
  • GOJ laceration secondary to retching
  • accounts for 5-10% UGI bleeding
  • 80-90% stop spontaneously
  • It is most important to control the vomiting as this is the precipitant
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4
Q

What is the treatment for UGI bleeding?

A
  • Stop offending drugs
  • May need blood; are they O Rh -ve?
  • Correct clotting (aim INR <1.5); Haem advice. FFP/Vit K/Beriplex
  • Platelet transfusion if <50
  • Consider antibiotics if risk of aspiration or varices
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5
Q

What is FFP

A
  • Fresh frozen plasma

- It contains all coagulation factors

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6
Q

Why must we avoid over transfusion in pts with UGI bleeding?

A

-Could cause pulmonary oedema

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7
Q

Outline the specific treatment for pts with UGI bleeding that is non-variceal

A

Proton pump inhibitors:

-Pantoprazole infusion: 80mg IV stat and then 8mg/hr for 72hrs

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8
Q

Outline the specific treatment for pts with UGI that is variceal

A

-These pts may have a distended abdomen, spider nevi, jaundice or encephalopathy

  1. )Terlipressin
    - Analogue of vasopressin. Causes vasoconstriction.(without causing vasoconstriction of the renal supply). Caution in IHD/PVD (2mg IV QDS-usually 72hrs max)
  2. ) Antibitioics (co-amoxiclav 1.2g IV TDS)
    - take abx cos bacteraemia & sepsis may follow pts who have had variceal bleeds
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9
Q

What is the aim of the Blatchford score ?

A

To identify pts that require clinical intervention (blood transfusion/OGD therapy)
-Doesn’t predict mortality

score=0
-minimal need for intervention so consider discharge

score >/= 6
->50% risk of needing an intervention

Factors:

  • Urea (mg/dL)
  • Haemoglobin (g/dL)
  • Systolic BP (mmHg)
  • Other parameters (pulse>100bpm; melena at presentation; syncope; hepatic disease; cardiac failure)
  • You need an intervention if you have a high score
  • Different for men & women cos pre-menopausal women often have iron deficiency anaemia
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10
Q

When does a UGI bleed pt need an OGD?

A
  1. )Severe bleed (Blatchford>/= 6 or ongoing haemodynamic instability )
    - urgent OGD once resuscitated
    - will need a protected airway
  2. ) Mild/moderate bleed
    - OGD within 24hrs of admission

-Give 250mg IV erythromycin 30mins before procedure

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11
Q

Why is erythomycin given before an OGD

A
  • To induce gastric emptying
  • Suggested that a pro-kinetic agent is needed before the OGD to clear the stomach and duodenum of any bloods that can get in the way of what we are trying to see
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12
Q

What is used to stop the bleeding during an endoscopy ng

A
  • 2 modalities
    1. )Band may be placed around an area of venous congestion and formed into a pseudopolyp
  • The band will stay on and scar over then drop off
    2. ) Angiodysplasia treatment
  • May use a technique that basically burns the area
  • Another modality may be applied if the area looks like it’s bleedi
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13
Q

What medicines must be stopped well before and endoscopy

A

-Blood thinners
eg warfarin or clopidogrel
-This is in order to prevent excessive bleeding during the endoscopy

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14
Q

What should be done after the OGD

A
  • Continue PPI,terlipressin, abx as advised
  • Rockall score
  • Clear fluids after 1 hour
  • Light diet after 6hrs
  • Monitor for signs of reblessing
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15
Q

What is the rockall score

A
  • Scoring system that aims to identify risk factors to predict mortality and risk of rebleeding
  • Requires OGD findings for full score
  • Doesn’t assess need for clinical intervention or predict those for out patient management
  • Score<3 =good prognosis
  • Score>8 = high mortality risk
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16
Q

What must be considered with a peptic ulcer?

A
  • Check and eradicate H. pylori
  • Omeprazole 40mg OD/BD 8 weeks
  • Repeat scope in 6-8 weeks if gastric ulcer
17
Q

What must be considered for varices

A
  • Propanolol or Carvedilol

- Endoscopic banding every 2-4weeks

18
Q

What are the characteristics of UGI bleeding

A
  • Serious probloem
  • Commonest GI disorder requiring admission
  • Mortality 7% ( 26% among inpatients)
  • 43% receive at least 1 unit blood
  • 2% required emergency surgery
19
Q

Outline the characteristics of a peptic ulcer

A
  • Commonly related to H pylori, NSAIDs or hypersecretory (gastrinoma)
  • Risk of malignancy
  • NEED to stop smoking
20
Q

What is a gastrinoma?

A
  • Tumor in the pancreas or duodenum that secretes excess of gastrin leading to ulceration in the duodenum, stomach and the small intestine.
  • There is hypersecretion of HCl acid into the duodenum, which causes the ulcers.
21
Q

What are the characteristics of

A
  • Prevalent in 50% population; 80% asymptomatic
  • CLO, urea breath test and serum IgG and stool antigen can be used
  • 7 day triple therapy-commonly PPI & amoxicillin & metronidazole
22
Q

How can we distinguish a gastric ulcer from a duodenal ulcer

A

-Gastric= worse on eating
-Duodenal= Better on eating
???check this with someone

23
Q

Outline the characteristics of gastric malignancy

A
  • > 90% adenocarcinoma
  • 2nd most common cancer worldwide
  • RF= H.pylori, smoking, preserved food, genetics
  • 5year survival=20%
24
Q

Outline the characteristics of oesophageal malignancy

A
  • Frequently SSC but adeno common in UK
  • Risk factors: Barrett’s, achalasia & betel nuts
  • Late presentation is common
25
Q

What are the characteristics of angiodysplasia ?

A
  • Found in 1-2% of OGDs
  • More common>60 years
  • Secondary to mucosal ischaemia or low grade obstruction of mucosal veins
  • Possible link with AV disease -Heyde’s syndroke
26
Q

What is oesophagitis

A

-commonly secondary to reflux’-LA grading system A-D(repeat OGD with C&D)

27
Q

What is gastritis

A
  • unlikely cause of bleeding

- associated with NSAIDs/alcohol/TB/h.pylori

Inflammation block (27 decks)

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