UGIB & LGIB

Question 1

Define UGIB

Answer 1

Blood loss within the intraluminal GIT from esophagus to duodenum ligament of Treitz

Question 2

Local causes of UGIB x3

Answer 2

1.Esophagus- esophagitis, varices, esophageal tumors
2.Stomach- ulcers, tumors, varices, erosive gastritis
3.Duodenum- ulcers, erosion, duodenitis

Question 3

Systemic causes of UGIB x4

Answer 3

Hemophilia- blood does not clot properly
Leukemia- blood cancer
Thrombocytopenia- low platelets
Anticoagulant therapy

Question 4

State 4 portosystemic shunts

Answer 4

Left gastric vein and esophageal veins
Superior and inferior rectal veins
Obliterated umbilical vein and epigastric veins
Retroperitoneal and diaphragmatic anastomoses

Question 5

Clinical features of portal HTN x4

Answer 5

1.Portal congestion> splenomegaly due to decreased venous flow into portal vein
2.Caput medusae- due to umbilical vein recanalization
3.Anorectal varices
4. Ascites

Question 6

Define PUD and 4 causes

Answer 6

An imbalance between acid secretion and mucosal defense mechanisms
1. H pylori infection
2. Acid hypersecretion
3. Cigarette smoking
4. NSAIDs

Question 7

Clinical presentation of UGIB x5

Answer 7

Malena
Dysphagia/odynophagia
Hematemesis
Abdominal pains
Chronic anemia symptoms
Stigmata of liver disease

Question 8

Management principles of UGIB x3

Answer 8

ABC with resuscitation
1. Assessment and replacement of blood
2. Diagnosis of source of bleeding
3. Treatment and control of source of bleeding

Question 9

State 5 high risk patients in UGIB

Answer 9

1. Endoscopy showing bleeding varices
2. Patient on anticoagulant or antiplatelet therapy
3. Significant chronic cardiac, pulmonary, renal and liver disease
4. Low Hb, hematemesis, tachycardia and hypotension
5. Age over 60 years

Question 10

Management of UGBI x4

Answer 10

Surgery
NG aspirate to determine source of bleeding + lavage in prep for endoscopy
Endoscopic therapy - banding, sclerotherapy injections
Sengstaken blakemore tube

Question 11

Presentation of LGIB x2

Answer 11

Hematochezia
Melena

Question 12

Define the 3 categories of bleeding

Answer 12

Massive - >1,5L/day low Hct <6g/dL

Moderate- Hct <8g/dL, presents as hematochezia or melena

Occult - 10ml of blood loss identified on lab test

Question 13

Aetiology of LGIB x6 groups

Answer 13

1.Inflammatory- ulcerative colitis, crohns
2.Vascular- ischemic colitis, hemangioma
3.Neoplastic - adenoma, polyps
4.Congenital - polyp, Meckels diverticulum
5. Miscellaneous - hemorrhoids, anal fissures
6. Clotting disorder - leukemia, DIC

Question 14

Medical management of anal fissure x5

Answer 14

Stool bulking agents - high fiber and stool softeners
Increased water intake
Nitroglycerin ointment to relive sphincter spasm and promote healing

Question 15

Define hemorrhoids and their function

Answer 15

They are cushions of submucosal tissue containing venules, arterioles and smooth muscle fibers
Act as part of continence mechanism, aid in complete closure of anal canal at rest

Question 16

Hemorrhoids result in increased risk of x3

Answer 16

Excessive straining
Increased abdominal pressure
Hard stools

Question 17

Types of hemorrhoids x2

Answer 17

External - distal to dentate line covered by anoderm
Internal - proximal to dentate line covered by anorectal mucosa

Question 18

Describe the 4 grades of hemorrhoids

Answer 18

1. No prolapse, prominent vessels
2. Prolapse with strain, spontaneous reduction
3. Prolapse with strain, manual reduction
4. Prolapsed and cant be reduced

Question 19

Management of hemorrhoids x4

Answer 19

Dietary fiber
Stool softener
Avoid straining
Increased fluid intake

Question 20

Interventions for hemorrhoid treatment x4

Answer 20

Rubber band ligation
Injectable sclerosing
Infrared coagulation
Hemorrhoidectomy

Question 21

Describe the mucosa in ulcerative colitis x3

Answer 21

Mucosa and submucosa infiltrated with inflammatory cells
Atrophic mucosa
Crypt abscesses

Question 22

Typical presentation of ulcerative colitis x2 and its key feature

Answer 22

Bloody diarrhea
Crampy abdominal pain
Involvement of the rectum

Question 23

Sate 3 pathologic findings of crohns disease

Answer 23

Mucosal lacerations
Inflammatory cell infiltrates
Non caesating granulomas

Question 24

What causes diverticular formation

Answer 24

Decreased fibre diet

Question 25

Purpose of colonoscopy in diverticular disease x3

Answer 25

Colonoscopy to identify bleed and treat with epinephrine or cautery

Question 26

Describe presentation of colorectal CA x3

Answer 26

1. Weight loss
2. Significant change in bowel habits
3. Painless bleeding, slow and intermittent
4. Associated with iron deficiency anemia

Question 27

Causes of ischemic colitis (2) and 4 risk factors

Answer 27

Caused by low blood flow or vascular occlusion
Hypertension, smoking, DM, Vascular inflammation or disease

Question 28

How does ischemic colitis present on xray

Answer 28

Thumb printing

Question 29

Investigations for ischemic colitis x4

Answer 29

Xray, sigmoidoscopy, CT, angiography

Question 30

Treatment of ischemic colitis x5

Answer 30

Bowel rest
Correct hypotension
Broad spectrum antibiotics
Surgical exploration
resection of gangrenous bowel

Question 31

Symptoms of angiodysplasia (3) and management x2

Answer 31

Anemia, melena, rectal bleeding
Colonoscopy- cauterization
Surgery - segmental resection

Question 32

Management of LGIB x3

Answer 32

Adequate resuscitation
Identify source of bleed and stop it
Prevent re bleeding