UGIB

Question 1

DDx UGIB in neonate

Answer 1

swallowed maternal blood
esophagitis
eso duplication
gastritis
gastric duplication
stress ulcer
duodenitis
vascular malformation
coagulopathy

Question 2

DDx UGIB in infants

Answer 2

esophagitis
eso duplication
mallory weiss tear
eso varices
aortoesophageal fistual
gastritis
gastric duplication
gastric varices
stress ulcer
duodenitis
vascular malformation
coagulopathy

Question 3

DDx UGIB in children

Answer 3

esophagitis
eso duplication
mallory weiss tear
eso varices
aortoesophageal fistual
gastritis
prolapse gastropathy
gastric duplication
gastric varices
stress ulcer
duodenitis
vascular malformation
coagulopathy
foreign body
toxic ingestion

Question 4

DDX UGIB in older children/adolescents

Answer 4

esophagitis
eso duplication
mallory weiss tear
eso varices
aortoesophageal fistual
gastritis
prolapse gastropathy
gastric duplication
gastric varices
stress ulcer
duodenitis
vascular malformation
coagulopathy
thrombocytopenia
foreign body
toxic ingestion

Question 5

Management of UGIB

Answer 5

ABCs
ETT if indicated
PRBC or crystalloids
NG placement and lavage
correct coagulopathy (FFP, PLT)
PPI
Octreotide
EGD
VCE
Radiolabeled RBC labelled
angiography
meckel’s scan

Question 6

Endoscopic management of varices

Answer 6

methods:
Endoscopic variceal ligation
Endoscopic sclerotherapy
Ballon Tamponade

Question 7

Endoscopic variceal ligation

Answer 7

-You can apply 4-5 in one session
-Start distally
-Less SE compared to sclerotherapy
-SE: chest pain, dysphagia, need multiple intubations

Question 8

Endoscopic sclerotherapy

Answer 8

-Thrombosis of varix and inflammation in surrounding tissue
-25G needle, 1-2ml injected in the varix; max 10 ml in total of 4-5 injections
-SE: ulceration, dysphagia, stricture, perforation, bacteremia, mediastinitis, dysmotility

Question 9

Ballon Tamponade

Answer 9

-pneumatic compression of lower eso and fundus
-sengstaken-blakemore tube (max 35 mmHg in peds).
-no longer that 24hr, risk of ischemia
-SE: recurrent bleeding, aspiration pneumonia, perforation

Question 10

Endoscopic management of non-variceal bleed

Answer 10

Injections
Thermocoagulation
Argon plasma coagulation
hemostatic clips

Question 11

Injections for non-variceal bleed

Answer 11

Injections: sclerosing agent, epinephrine
Epi 1:10,000 dilution in NS (1ml 1:1000 epi +9ml NS)
- epi is best when used alone
- don’t inject epi near GEJ, risk of passage to enteric circulation
SE: necrosis, bleeding, ischemia, perforation

Question 12

Thermocoagulation for non-variceal bleed

Answer 12

Heater probe: heat around bleeding site. SE: ulceration
Monopolar probe: continuous current –>tissue coagulation; SE: tissue injury, adherence
Bipolar probe: energy transmitted from one electrode to another; SE: perforation

Question 13

Argon plasma coagulation for non-variceal bleed

Answer 13

-current through ionized argon gas
-depth of tissue penetration depends on the power
-used for superficial ectasia, post polypectomy bleed, ulcer homeostasis