PUD & Haematemesis

Question 1

What is the most common type of peptic ulcer?

Answer 1

Duodenal

Question 2

Differentiate between a gastric & duodenal ulcer?

Answer 2

Gastric - post-prandial pain
Duodenal - pre-prandial pain

Question 3

Why might a duodenal ulcer present with haematemesis?

Answer 3

Perforation

• esp if posterior duodenal ulcer as GDA lies closely posterior to the duodenum

Question 4

What is a Mallory-Weiss tear?

Answer 4

Mucosal tear at GOJ
- often caused by severe vomiting

Question 5

What is a Cushing’s ulcer?

Answer 5

Deeply penetrating peptic ulcers in patients with neuro disease.

• raised ICP due to intracranial injury/trauma
• overstimulation of vagus
• increased gastric acid production

Question 6

What is a Curling’s ulcer?

Answer 6

Ulcer following severe burns

• acute reduced plasma volume (hypovolaemia) = tissue necrosis & ischaemia
• gastric erosion

Question 7

Boerhaave’s syndrome

Answer 7

Spontaneous rupture of oesophagus due to pressure differences

• severe straining
• severe vomiting

(oesophagus (+) & thorax (-))

Question 8

How might Boerhaave’s syndrome classically present?

Answer 8

Mackler’s triad:

1. Vomiting
2. Chest pain
3. Subcutaneous emphysema (bubble wrap sounds)

Question 9

How would a perforation typically show on a contrast CT?

Answer 9

Pneumoperitoneum

Question 10

What malaena hx indicates an upper GI bleed over a lower?

Answer 10

Black, tarry stools (not fresh, red blood)

Question 11

What is the initial management of an upper GI bleed?

Answer 11

Keep NBM
Insert 2 large bore IV cannulae
- resus with IV fluids & transfusion (saline/Hartmann’s)
(Can lose a large volume quickly)

Question 12

What is the Rockall risk score?

Answer 12

Predicts mortality risk in upper GI bleed
(>0 need OGD, outpt if not)

Includes:
Age >60
SBP, HR >100
Comorbidities & endoscopy findings

Question 13

What are the most common causes of upper GI bleeds?

Answer 13

• oesophageal/gastric varices
• PUD (H.pylori, NSAIDs, smoking)
• aortic-enteric fistulae (prev AAA/graft)
• angiodysplasia
• MVT

Question 14

What is the Glasgow-Blatchford score?

Answer 14

NICE-recommended scoring system for timing of OGD

Based on:
- urea
- SBP & HR
- Hb
- malaena, syncope, LD, HF

Question 15

Which biochemical abnormality is indicative of an upper GI bleed? Why?

Answer 15

High urea - haemolysis by gut bacteria (‘protein meal’)