UGIB Flashcards
1
Q
Melena blood come from
A
Proximal to ligament of Treitz
2
Q
Definition of portal hypertension
A
Portal venous pressure of 6mmHg and above
- >= 12mmHg: high risk of variceal bleed and ascites
3
Q
Complications of portal hypertension
A
- Ascites
- Formation of portosystemic shunt
- Portal hypertensive gastropathy
- Congestive splenomegaly
- Hepatic encephalopathy
4
Q
Location of portosystemic shunt
A
- Esophageal varices: esophageal branch of left gastric vein + esophageal branch of azygos vein
- Rectal varices: superior rectal vein + middle rectal and inferior rectal vein
- Paraumbiliccal: paraumbiliccal vein + superficial epigastric veins
5
Q
Gastric vs Duodenal Ulcer in History
A
- Duodenal: pain occur 3-5 hours after mean (hunger pain)
- Gastric ulcer: pain exacerbated with food intake
6
Q
Investigation for PUD
A
- OGDS
- FBC
- Fasting serum gastrin
- Urea breath test
7
Q
How NSAID cause peptic ulcer disease
A
- Often in greater curvature
- It impair mucosal prostaglandin synthesis (mucin production, mucosal bicarbonate secretion, maintaining mucosal blood flow)
8
Q
When do you rescope for Gastric ulcer
A
- In 6 weeks
- If still present, biopsy again and do antral biopsy for CLO test
9
Q
How H. pylori cause PUD
A
- Urease neutralize the hostile acidic condition
- Movement toward epithelium cells by flagella-mediated motility
- Attachment to host cells by adhesin/ receptor interaction
- Causing tissue damage by toxin release (eg: CagA, Vac A)
10
Q
Define peptic ulcer
A
- Defect in the gastric or duodenal mucosa that extends through the muscularis mucosa into the deeper layer of the wall
11
Q
4 other sites of peptic ulcer
A
- Stomach (lesser curvature, antrum)
- Stomal ulcer (gastroenterostomy)
- Meckel’s diverticulitis
- Distal duodenum and jejunum
12
Q
4 complications of chronic duodenal ulcer
A
- Internal bleeding
- Perforation
- Obstruction
- Penetration
