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Medicine Y3 Placement > Peptic Ulcer & Upper GI bleeds > Flashcards

Peptic Ulcer & Upper GI bleeds Flashcards

1
Q

what does a peptic ulcer involve

A

ulceration of the mucosa of the stomach (peptic ulcer) or the duodenum (duodenal ulcer)

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2
Q

which peptic ulcer is more common

A

duodenal ulcer

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3
Q

stomach mucosa is prone to ulceration from

A

breakdown of the protective layer of the stomach and duodenum & increase in stomach acid

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4
Q

What is the protective layer of the stomach compromised of and what can it be broken down by

A

mucus and bicarbonate secreted by the stomach mucosa

broken down by: medications (steroids and NSAIDS) and H.pylori

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5
Q

what can cause an increase in acid

A
  • Stress
  • Alcohol
  • Caffeine
  • Smoking
  • Spicy foods
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6
Q

how does someone with peptic ulcers present

A
  • Epigastric discomfort or pain
  • Nausea and vomiting
  • Dyspepsia
  • Bleeding causing haematemesis, “coffee ground” vomiting and melaena
  • Iron deficiency anaemia (due to constant bleeding)
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7
Q

Eating typically worsens the pain in which condition

  • gastric ulcers
  • duodenal ulcers
A

gastric ulcers

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8
Q

eating improves the pain in which condition

  • gastric ulcers
  • duodenal ulcers
A

duodenal ulcers

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9
Q

How are peptic ulcers managed

A

diagnosed by endoscopy (do the rapid urease test to check for H.Pylori)
treatment is the same as with GORD, usually with high dose PPI

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10
Q

what are the complications of peptic ulcers

A

bleeding from the ulcer
perforation resulting in an ‘acute abdomen’ and ‘peritonitis’
Scaring and strictures of the muscle and mucosa can lead to narrowing of the pylorus

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11
Q

Upper GI tract bleed can be from which structures

A

oesophagus
stomach
duodenum

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12
Q

what are the pain causes of upper GI bleeds

A

oesophageal varices
mallory-weirs tear, which is a tear of the oesophageal mucous membrane
Ulcers of the stomach of duodenum
Cancer of the stomach or duodenum

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13
Q

what is a mallory-weiss tear

A

tear of the oesophageal mucous membrane

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14
Q

How does someone with an upper GI bleed present

A
  • Haematemesis (vomiting blood)
  • “Coffee ground” vomit. This is caused by vomiting digested blood that looks like coffee grounds.
  • Melaena, which is tar like, black, greasy and offensive stools caused by digested blood
  • Haemodynamic instability occurs in large blood loss, causing a low blood pressure, tachycardia and other signs of shock. Bear in mind that young, fit patients may compensate well until they have lost a lot of blood.
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15
Q

What other main symptoms will a patient have if they have a peptic ulcer

A

epigastric pain and dyspepsia

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16
Q

What is the scoring system that is used in suspected upper GI bleed on their initial presentation

A

Glasgow-Blatchford Score

17
Q

What kind of things does the glasgow-blatchford score take into account

A 
drop in Hb
rise in urea
blood pressure 
HR
melaena 
syncope
18
Q

Why does urea rise in upper GI bleeds

A

blood in the GI tract gets broken down by the acid and digestive enzymes
one of the breakdown products is urea and then this urea is absorbed in the intestines

19
Q

What score is used for patients that have had an endoscopy to calculate their risk of rebreeding and mortality

A

Rockall Score

20
Q

What risk factors does the Rockall score take into account

A
  • Age
  • Features of shock (e.g. tachycardia or hypotension)
  • Co-morbidities
  • Cause of bleeding (e.g. Mallory-Weiss tear or malignancy)
  • Endoscopic stigmata of recent haemorrhage such as clots or visible bleeding vessels
21
Q

What is the management of an upper GI bleed (ABATED)

A
  • A – ABCDE approach to immediate resuscitation
  • B – Bloods
  • A – Access (ideally 2 large bore cannula)
  • T – Transfuse
  • E – Endoscopy (arrange urgent endoscopy within 24 hours)
  • D – Drugs (stop anticoagulants and NSAIDs)
22
Q

What drugs should you stop if someone is having an upper GI bleed

A

anticoags and NSAIDs

23
Q

What is group and save

A

the lab simply check the patients blood group and keeps a sample of their blood saved in case they need to match blood to it

24
Q

what is crossmatch

A

the lab actually finds blood, tests that it is compatible and keeps it ready in the fridge to be used if necessary.

25
Q

In what circumstances are platelets indicated

A

in active bleeding and thrombocytopenia (platelets less than 50)

26
Q

What is given to patients taking warfarin that are actively bleeding

A

prothrombin complex concentrate

27
Q

Patients with a history of chronic liver disease are more susceptible to what kind of bleeding

A

oesophageal varices

28
Q

What medications are used to treat someone with oesophageal varies

A

Terlipressin

Prophylactic broad spectrum antibiotic

Medicine Y3 Placement (10 decks)

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