TH3 ACUTE GASTRO BLEEDING/ PEPTIC ULCER Flashcards
HEMATOMESIS?
VOMITING BLOOD
DARK/ BROWN MATERIAL (coffee grounds)
> due to Hb > reduced > HEMATIN by HCl
MELENA
TARRY BLACK STOOL
> GI BLEEDING PRESENTED WITH MELENA
> at least 50ml of blood in intestine for > 8hrs
> source of bleeding = proximal to flexura coli hepatica
> BLACK COLOUR = IRON SULPHITE > produced by bacterial disintegration of Hb
HEMATOCHESIA?
> defecation of blood
rectrorhagia
intestinal bleeding distal to flexura coli hepatica
ACUTE UPPER GASTRO INTESTINAL BLEEDING?
> ESOPHAGUS
STOMACH
DUODENUM
> haemorrhage proximal to LIGEMENTUM TREITZ (duodenum-jejunum connection)
WHICH 2 DISEASE PRESENTS HEMATOCHESIA WITH MASSIVE HEMORRHAGE?
ULCERUS COLITIS
LARGE INTESTINAL DIVERTICULOSIS
> FRESH BLOOD IN STOOL
BLOODY DIARRHOEA
WHAT IS TYPICAL BLEEDING IN CASE OF HEMORRHOIDS?
RECTAL BLEEDING
> fresh blood not mixed with stool
> during defecation or immediately after defecation
WHAT IS MALLORY WEISS SYNDROME?
LINEAR TEARING OF ESOPHAGEAL MUCOSA DUE TO REPEATED VOMITING
MOST COMMON CAUSE OF UPPER GASTRO INTESTINAL BLEEDING?
PEPTIC ULCER
> cause of more than 2/3 of GI bleeding
MAIN METHOD FOR DX GI BLEEDING?
EMERGENCY UPPER ENDOSCOPY
oesophago-gastro-duodenoscopy
WHICH CLASSIFICATION IS USED TO DETERMINE THE ENDOSCOPIC SEVERITY OF STOMACH + DUODENAL ULCER BLEEDING?
FOREST CLASSIFICATION (6) 1a - spurting bleeding 1b - oozing bleeding 2a - visible vessel 2b - adherent dot 2c - black spots 3 - clear base
COMPLICATION OF PEPTIC ULCER?
> HEMORRHAGE > PERFORATION > GASTRIC OUTLET OBSTRUCTION > PENETRATION + FISTULA > MALIGNANT CHANGE IN PEPTIC ULCER
MOST COMMON COMPLICATION OF PEPTIC ULCER?
HEMORRHAGE
WHICH ARE THE PHASES OF MANAGEMENT IN PEPTIC ULCER?
MANAGEMENT OF HEMORRHAGE > 5 PHASES 1. resuscitation 2. diagnosis 3. immediate control of bleeding 4. prevention of re-bleeding 5. prevention of recurrent bleeding in future
WHAT DOES PEPTIC ULCER PERFORATION MEAN?
EXACERBATION OF PEPTIC ULCER > CAUSING NECROSIS + PERFORATION WITH SPILLAGE OF CAUSTIC GASTRIC CONENT INTO PERITONEUM
CLASSIFICAL RADIOLOGICAL SIGN OF PERFORATED PEPTIC ULCER?
PNEUMOPERITOENUM
> AIR IN PERITONEAL CAVITY
> air seen under diaphragm > X RAY
CLINICAL PRESENTATION OF PERFORATED PEPTIC ULCER?
SUDDEN + SEVERE EPIGASTRIC PAIN
> PHYSICAL EXAMINATION > RIGIDITY OF ABDOMINAL MUSCULATURE
AFTER PEPTIC ULCER PERFORATION, WHICH IS THE NEXT DISEASE RELATED WITH PERFORATION + AIR UNDER DIAPHRAGM ON X RAY?
PERFORATED DIVERTUCULUM OF COLON
TYPES OF GASTRIC OUTLET OBSTRUCTION?
ACUTE
CHRONIC
WHAT IS THE CAUSE OF ACUTE GASTRIC OUTLET OBSTRUCTION?
EDEMA + INFLAMMATION OF PYLORIC CHANNEL
WHAT IS THE CAUSE OF CHRONIC GASTRIC OUTLET OBSTRUCTION?
REPEATED EPISODES OF ULCERATION + HEALING
> LEAD TO PYLORIC SCARRING + FIXED STENOSIS FORMED WITH GASTRIC OUTLET OBSTRUCTION
WHICH IS THE DX METHOD FOR GASTRIC OUTLET OBSTRUCTION?
UPPER ENDOSCOPY
> CONFIRMS NATURE OF OBSTRUCTION
EXPLAIN PENETRATION + FISTULA FORMATION IN PEPTIC ULCER?
REPEARED EPISODES OF ULCERATION + HEALING > lead to adhesion between stomach + adjacent organs - pancreas - biliary tree - - transverse colon
WHICH ORGAN MOST COMMONLY AFFECTED BY ULCER PENETRATION?
PANCREAS
> body, tail or head
MOST COMMON TYPE OF FISTULA FORMATION IN PEPTIC ULCER?
GATROCOLIC FISTULA
> gastric ulcer of greater curvature > cause gastrocolic fistula
