UGIB

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Question 3

most common cause of UGIB

Answer 3

esophageal varices - chronic liver disease
or peptic ulcer disease.

Question 4

clinical features of UGIB ?

Answer 4

haematemesis - if oesophageal varices - then Usually a large volume of fresh blood
often bright red but may sometimes be described as ‘coffee gound’

melena
the passage of altered blood per rectum
typically black and ‘tarry’

Question 5

dd of UGIB of oesophageal origin other than oesophageal varices

Answer 5

Oesophagitis - small vol of blood , ceases spontaneously , history of antecedent GORD type symptoms.

Cancer Usually small volume of blood, dysphagia

Mallory Weiss tear Typically brisk small to moderate volume of bright red blood following a bout of repeated vomiting. Malena rare.

Question 6

dd of UGIB gastric origin causes

Answer 6

Gastric ulcer Small low volume bleeds are more common so would tend to present as iron deficiency anaemia.

Gastric cancer May be frank haematemesis or altered blood mixed with vomit. Usually prodromal features of dyspepsia

Dieulafoy lesion Often no prodromal features prior to haematemesis and melena, but this arteriovenous malformation may produce quite a considerable haemorrhage and may be difficult to detect endoscopically

Diffuse erosive gastritis - Usually haematemesis and epigastric discomfort. Usually underlying cause such as recent NSAID usage. Large volume haemorrhage may occur with considerable haemodynamic compromise

Question 7

dd of UGIB of duodenal cause ?

Answer 7

Duodenal ulcer -
usually posteriorly sited and may erode the gastroduodenal artery. However, ulcers at any site in the duodenum may present with haematemesis, melena and epigastric discomfort.

The pain of a duodenal ulcer is slightly different to that of gastric ulcers and often occurs several hours after eating.

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Aorto-enteric fistula - In patients with previous abdominal aortic aneurysm surgery - aorto-enteric fistulation remains - rare but important cause of major haemorrhage associated with high mortality.

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Question 12

risk assessment for UGIB?

Answer 12

Glasgow-Blatchford - decide whether patient patients can be managed as outpatients or not
score of 0 may be considered for early discharge.

Rockall score - used after endoscopy
provides a percentage risk of rebleeding and mortality

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Question 19

management of non varicieal bleeding ?

Answer 19

non-variceal bleeding - do not recommend the use of proton pump inhibitors (PPIs) before endoscopy

PPI infusions have only ever been shown to be effective in acute upper GI bleeding post endoscopy in patients with stigmata of recent haemorrhage

endoscopy, interventional radiology and surgery

Question 20

management of non vatical bleeding ?

Answer 20

terlipressin and prophylactic antibiotics should be given to patients at presentation (i.e. before endoscopy)

band ligation should be used for oesophageal varices

injections of N-butyl-2-cyanoacrylate for patients with gastric varices

transjugular intrahepatic portosystemic shunts (TIPS) should be offered if bleeding from varices is not controlled with the above measures