Peptic Ulceration

Question 1

What causes it?

Answer 1

Imbalance between mucous and acid secretion

Usually H.Pylori related

Question 2

Where does it affect?

Answer 2

Lower oesophagus
Body and antrum of stomach
First and second parts of duodenum

Question 3

What can bleeding cause acutely and chronicly?

Answer 3

Acute=haemhorrge

Chronic=anemia

Question 4

What can perforation and healing by fibrosis lead to?

Answer 4

Peritonitis

Obstruction

Question 5

S+S of peptic ulcers

Answer 5

Epigastric pain
Nocturnal/hunger pain
Back pain
Nausea and vomiting 
Weight loss and anorexia 
Haematesis/melaena/anemia

Question 6

Tx for H.pylori eradication

Answer 6

Triple therapy for 7 days

• clarithromycin
• amoxicillin
• • tetracycline if penicillin allergy
• PPI
• -eg omeprazole

Question 7

S+S of upper GI bleeding

Answer 7

Haematemesis
Malena
Elevated urea
Associated with:
-dyspepsia 
-reflux
-epigastric pain

Question 8

Lower GI bleeding S+S

Answer 8

Fresh blood/clots
Magenta stools
Normal urea
Typically painless
More common in advanced age

Question 9

Common oesophageal causes of upper GI bleeding

Answer 9

Oesophageal varices
Mallory Weiss tear
Oesophageal malignancy

Question 10

Stomach causes of upper GI bleeding

Answer 10

Gastric ulcer
Gastritis 
Gastric varices 
Portal hypertension 
Dieulafoy
Angiodysplasia

Question 11

Duodenal causes of upper GI bleeding

Answer 11

Angiodysplasia

Question 12

RFs for peptic ulcers?

Answer 12

NSAIDS
Steroids
Anti-coagulant 
Anti-platelet agents
Alcohol
Smoking
FH of peptic ulcers, H.Pylori infections 
Systemic illness eg stress ulcers

Question 13

Tx for acute GI haemorrhage

Answer 13

PPI
Endoscopy with endotherapy
Angiography with metabolization
Laparotomy 
Endoscopic therapy 
-injection
- -Adrenaline
-thermal
-mechanical
-haemospray (inert powder delivered by CO2)

Question 14

What are varices?

Answer 14

Arise secondary to portal hypertension, usually due to liver cirrhosis
Abnormally dilated collateral vessels
Increases in portal pressure (eg infection/drug use) can precipitate bleeding

Question 15

RFs for gastritis and duodentitis

Answer 15

Similar to the RFs for peptic ulcers
Tend to bleed in the context of impaired coagulation 
Reflux oesophagitis 
Hiatus hernia 
Alcohol
Bisphosphonates 
Systemic illness

Question 16

What’s a diuelafoy?

Answer 16

Submucosal arteriolar vessels eroding through mucosa

Gastric fundus

Question 17

What’s angiodysplasia?

Answer 17

Vascular malformation
Occurs anywhere in GIT
Frequent cause of chronic occult or overt occult bleeding
Associated with chronic conditions including heart valve replacement

Question 18

Tx for varices

Answer 18

Endotherapy

• oesophageal
• -band litigation
• -glue injection
• gastric
• -glue injection
• rectal
• -glue injection

IV terlipressin

• vasoconstriction of splenic blood supply
• reducing portal vein flow
• reducing portal pressure

Question 19

Colonic causes of acute lower GI bleeding

Answer 19

Diverticular disease
Haemorrhoids
Angiodysplasia 
Neoplasia 
Ischemic colitis 
Radiation enteropathy/proctitis 
IBD

Question 20

What’s diverticular disease?

Answer 20

Protrusion of the inner mucosal lining though the outer muscular layer forming a pouch

Question 21

Diverticulitis vs diverticulosis

Answer 21

Diverticulitis= inflammation 
Diverticulosis= presence

Question 22

What’re haemorrhoids and what’re they associated with?

Answer 22

Enlarged vascular cushions around the anal canal

Association with straining/constipation/low fibre diets

Question 23

How does ischemic colitis normally present?

Answer 23

Bleeding
Crampy abdominal pain
Usually self limiting
Dusky blue, swollen mucosa

Question 24

Tx for radiation colitis

Answer 24

APC (argon plasma coagulation)
Sulcrafate enemas
Hyperbaric O2

Question 25

Causes of acute lower GI bleeding

Answer 25

Meckel’s diverticulum (congenital bulge in GI tract, 2ft from ilieocaecal valve, 2 inches long)
Small bowel angiodysplasia
Small bowel tumour
Small bowel ulceration (NSAIDS associated)
Aporto entero fistula- following AAA repair

Question 26

S+S of shock

Answer 26

Tachypnea 
Tachycardia 
Anxiety or confusion
Cool or clammy skin
Oliguria (low urine output)
Hypotension

Question 27

What score on the Blatchford score is associated with a greater than 50% risk of needing an intervention?

Answer 27

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