Peptic Ulceration and GI Bleeding

Question 1

What is the most common cause of GI bleeding?

What is the second most common?

Answer 1

1) Peptic ulceration

2) oesophagitis/gastritis

Question 2

What are the 2 types of peptic ulcer?

Why are they called this?

Answer 2

1) gastric = in the stomach

2) duodenal = in the duodenum

Question 3

What does peptic mean?

Answer 3

An area of the body that usually has an acidic lumen

Question 4

What is the treatment for non-variceal causes of GI bleeding?

Answer 4

PPI’s to prevent further ulceration (as peptic ulcer is most likely cause)

Question 5

What is the treatment for variceal causes of GI bleeding?

Answer 5

Terlipressin to vasoconstrict

Question 6

What score system determines those at higher risk and therefore in need of intervention (transfusion and OGD therapy) with upper GI bleed?

What is a benchmark/cut-off for this scoring system?

Answer 6

Blatchford score

> 6 = >50% risk of needing an intervention

Question 7

Which scoring system aims to predict risk of mortality and re-bleeding post-GI bleed?

What is a downside of this scoring system?

Answer 7

Rockall

Requires an OGD to determine the full score

Question 8

What is another name for H. Pylori?

What gram stain is this bacteria?

What is the relevance of this bacteria?

Answer 8

Campylobacter pylori

Gram -ve

Sometimes found in the body, usually asymptomatic, BUT can be a major cause of peptic ulceration

Risk factor for adenocarcinoma

Question 9

What is the name given to a laceration at the gastro-oesophageal junction caused by repeated retching?

Answer 9

Mallory-Weiss tear

Question 10

How does smoking increase peptic ulcer risk?

Answer 10

Dampens mucosal protective mechanisms giving H. Pylori a higher chance of infecting

Question 11

What is a TIPSS procedure and when is it indicated?

Answer 11

Transjugular (via jugular vein) Intrahepatic (liver) Portosystemic Shunt (shunt of liver portal vein system)

This is indicated in oesophageal varices due to liver cirrhosis/CLD to reduce the varices and pressure by shunting the liver portal vasculature to keep it open and not closed due to the cirrhosis and fibrosis seen in CLD

Question 12

What is the most common gastric cancer?

What about oesophageal?

Answer 12

Adenocarcinoma

Same but also squamous cell carcinoma

Question 13

What is Heyde’s Syndrome?

Answer 13

GI bleeding from angiodysplasia in the presence of Aortic Stenosis