Peptic Ulceration Flashcards
What causes it?
Imbalance between mucous and acid secretion
Usually H.Pylori related
Where does it affect?
Lower oesophagus
Body and antrum of stomach
First and second parts of duodenum
What can bleeding cause acutely and chronicly?
Acute=haemhorrge
Chronic=anemia
What can perforation and healing by fibrosis lead to?
Peritonitis
Obstruction
S+S of peptic ulcers
Epigastric pain Nocturnal/hunger pain Back pain Nausea and vomiting Weight loss and anorexia Haematesis/melaena/anemia
Tx for H.pylori eradication
Triple therapy for 7 days
- clarithromycin
- amoxicillin
- tetracycline if penicillin allergy
- PPI
- -eg omeprazole
S+S of upper GI bleeding
Haematemesis Malena Elevated urea Associated with: -dyspepsia -reflux -epigastric pain
Lower GI bleeding S+S
Fresh blood/clots Magenta stools Normal urea Typically painless More common in advanced age
Common oesophageal causes of upper GI bleeding
Oesophageal varices
Mallory Weiss tear
Oesophageal malignancy
Stomach causes of upper GI bleeding
Gastric ulcer Gastritis Gastric varices Portal hypertension Dieulafoy Angiodysplasia
Duodenal causes of upper GI bleeding
Angiodysplasia
RFs for peptic ulcers?
NSAIDS Steroids Anti-coagulant Anti-platelet agents Alcohol Smoking FH of peptic ulcers, H.Pylori infections Systemic illness eg stress ulcers
Tx for acute GI haemorrhage
PPI Endoscopy with endotherapy Angiography with metabolization Laparotomy Endoscopic therapy -injection - -Adrenaline -thermal -mechanical -haemospray (inert powder delivered by CO2)
What are varices?
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
RFs for gastritis and duodentitis
Similar to the RFs for peptic ulcers Tend to bleed in the context of impaired coagulation Reflux oesophagitis Hiatus hernia Alcohol Bisphosphonates Systemic illness
What’s a diuelafoy?
Submucosal arteriolar vessels eroding through mucosa
Gastric fundus
What’s angiodysplasia?
Vascular malformation
Occurs anywhere in GIT
Frequent cause of chronic occult or overt occult bleeding
Associated with chronic conditions including heart valve replacement
Tx for varices
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
Colonic causes of acute lower GI bleeding
Diverticular disease Haemorrhoids Angiodysplasia Neoplasia Ischemic colitis Radiation enteropathy/proctitis IBD
What’s diverticular disease?
Protrusion of the inner mucosal lining though the outer muscular layer forming a pouch
Diverticulitis vs diverticulosis
Diverticulitis= inflammation Diverticulosis= presence
What’re haemorrhoids and what’re they associated with?
Enlarged vascular cushions around the anal canal
Association with straining/constipation/low fibre diets
How does ischemic colitis normally present?
Bleeding
Crampy abdominal pain
Usually self limiting
Dusky blue, swollen mucosa
Tx for radiation colitis
APC (argon plasma coagulation)
Sulcrafate enemas
Hyperbaric O2
Causes of acute lower GI bleeding
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
S+S of shock
Tachypnea Tachycardia Anxiety or confusion Cool or clammy skin Oliguria (low urine output) Hypotension
What score on the Blatchford score is associated with a greater than 50% risk of needing an intervention?
> 6
