U GI Bleeding

Question 1

(Acute) Most likely cause of tender and epigastrium, coffee ground vomit and black stools

Answer 1

Duodenal Ulcer

Question 2

Bacterium associated with Peptic ulcer disease?

Answer 2

Gram negative spiral/H Pylori

Question 3

Pathophysiology of oesophageal varcieal bleed?

Answer 3

Increased pressure in the left gastric vein, portal hypertension

Question 4

What clinical signs would you expect in Oesophageal varcies?

Answer 4

1. Clubbing 2. Jaundice 3. Spider Neavi 4. Organomegaly OR

Shock

Question 5

What background/history would a person with a Mallory Weiss come into the GP for?

Answer 5

1. Retching/vomiting OR

2. Alcohol excess

Question 6

What clinical findings would you expect a person with Boerhaave syndrome or a oesphageal rupture?

Answer 6

1.Retrosternal chest pain +/- epigastric pain 2. Subutaneous emphysema, SOB 3. Fever 4. Haemodynamically unstable

Question 7

First Line Management for Oesophageal Varcies (haemorrhage)

Answer 7

Terlipressin, prophylaxis antibiotics (quionoles) and endoscopic varicela band ligation

Question 8

Causes of Oesphageal rupture

Answer 8

Vomiting
Endoscopy
Alcohol abuse
Clonorchis sinesensis

Question 9

What bloods would you request for a UGIB?

Answer 9

FBC: anaemia or normal hb in acute bleed
LFTs
coagulation profile
U&Es: raised urea
Cross match, G&S
Amylase
VBG: lactate rose May suggest poor tissue perfusion

Question 10

Management for Bleeding peptic ulcer

Answer 10

Clipping +/- adrenaline
Thermal coagulation with adrenaline
Sclerotherapy with adrenaline

Question 11

What screening tool is used to determine whether a UGIB requires secondary intervention?

Answer 11

Glasgow Blatchford Score
0 - consider discharge and return for outpatient endoscopy
>0: requires admission for inpatient endoscopy