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3A week 4 - HPB, malabsoprtion and EDs > Upper and lower GI bleeding > Flashcards

Upper and lower GI bleeding Flashcards

1
Q

what types of muscle is the oesophagus comprised of (3)

A
  1. striated, voluntary muscle in the upper 1/3
  2. smooth, involuntary muscle in the lower 1/3
  3. mixture of both in the middle third
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2
Q

at what vertebral level is the cervicle oesophagus at

A

C6

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2
Q

what are the 2 sphincters that are at either end of the oesphagus

A
  1. upper oesophageal sphincter
  2. lower oesophageal sphincter
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3
Q

what is the arterial and venous supply of the cervical oesphagus

A

inferior thyroid artery/vein

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4
Q

what is there arterial and venous supply of the thoracic oesophagus

A

arterial - oesophageal branches of the thoracic artery
venous - azygous system

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5
Q

what is there arterial and venous supply of the abdominal oesophagus

A

arterial - left gastric artery
venous - portal system

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6
Q

what ligament does the lesser curvature give rise to

A

hepatogastric ligament

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7
Q

what is the arterial supply of the fundusand upper body of the stomach

A

the short and posterior gastric branches of the splenic artery

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8
Q

what is the arterial supply of the pylorus of the stomach

A

the gastroduodenal artery (branch of the common hepatic)

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9
Q

what is the cardia of the stomach

A

the opening of the oesophagus into the stomach

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10
Q

what areas does the small bowel develop from (2)

A
  1. the distal foregut
  2. midgut
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11
Q

what are the 3 main structures of the small bowel

A
  1. distal duodenum
  2. jejenum
  3. ileum
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12
Q

what is the main artery that supplied the small bowel

A

superior mesenteric artery

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13
Q

what do pancreatic secretions and bile do in the duodenum

A

break down chyme into sugars, amino acids and fatty acids

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14
Q

what does the jejenum primarily absorb (2)

A
  1. water
  2. micronutrients
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15
Q

what does the terminal ileum absorb (2)

A
  1. vit B12
  2. bile acids
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16
Q

what is the ampulla of vater

A

the spot where the pancreatic and bile ducts release their secretions into the intestines

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17
Q

what is the etymology of jejenum

A

from the latin jejenus meaning ‘fasting’as it was often found empty

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18
Q

what is different about he proximal 40% of the jejenum

A

the lumen is wider and thicker than the rest with more prominent mucosal folds

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19
Q

what are the names of the mucosal folds in the jejenum

A

valvulae conniventes

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20
Q

is there a clear demarcation between thee ileum and jejenum

A

no

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21
Q

what does the ileum have more of compared to the jejenum (2)

A
  1. lymph nodes
  2. peyer’s patches
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22
Q

what are peyers patches

A

clusters of subepithelial, lymphoid follicles found in the intestine

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23
Q

what is the average length of the ileum

A

2m

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24
Q

what is the main venous drainage of the small bowel

A

portal vein

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25
Q

where doe the colon extend from and to

A

extends from the cecum to the anal canal

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26
Q

what is absorbed in the colon (2)

A

water and electrolytes

27
Q

what are the 4 parts of the colon

A
  1. ascending
  2. transverse
  3. descending
  4. sigmoid
28
Q

what artery supplies the hind gut

A

inferior mesenteric artery

29
Q

which artery supply the ascending colon

A

ileocolic - branch of the sma

30
Q

what arteries supply the transverse colon

A

the SMA (right and middle colic arteries) and IMA (left colic artery) - it is both mid and hind gut

31
Q

what artery supplies the descending colon

A

left colic artery (branch of the IMA)

32
Q

what does the superior mesenteric vein drain (4)

A
  1. small intestine
  2. cecum
  3. asending colon
  4. transverse colon
33
Q

what does the inferior mesenteric vein drain (3)

A
  1. descending colon
  2. sigmoid
  3. rectum
34
Q

which 3 veins join together to make the portal vein

A

SMV, IMV, splenic

35
Q

what anatomical marker is sued to differentiate between an upper and lower GI bleed

A

the ligament of treitz - supports and anchors the duodenum, without it intestinal twisting can occur

36
Q

causes of an upper GI bleed (6)

A
  1. peptic ulcer
  2. oesophagus varices
  3. oesophagitis
  4. mallory weiss tear
  5. AV malformation
  6. upper GI cancers
37
Q

causes of a lower GI bleed (5)

A
  1. diverticulosis
  2. haemorrhoids
  3. colorectal cancer
  4. mesenteric ischaemia
  5. AV malformations
38
Q

what is haematemesis

A

vomiting fresh or altered blood

39
Q

what is haematochezia

A

bright red rectal bleeding

40
Q

what is occult bleeding

A

blood in the feces that is not visibly apparent

41
Q

where is the disease site if haematemesis is seen

A

proximal to the ligament of treitz (upper GI)

42
Q

where is the disease site if
melaena is seen

A

upper GI - jejenal usually; can be ileal and right colon also

43
Q

where is the disease site if
bright red rectal bleeding is seen

A

usually ileo-colonic; rarely - rapid upper tract bleeding

44
Q

what pumps are responsible for gastric acid secretion

A
  1. Acid secretion occurs through gastric proton pumps located in parietal cells;
  2. These are hydrogen-potassium ATPase pumps (H+ into gastric lumen and K+ out), At rest, these pumps are located intracellularly;
45
Q

what can stimulate parietal cells and what does this stimulation cause to happen

A

Simulation of parietal cells by a combination of Ach (vagus nerve) gastrin (antral G cells) and histamine (enterochromaffin like cells) translocate the proton pumps to the apical secretory canalicular (luminal) membrane;

46
Q

what happens in the cephalic phase of a meal

A

During the cephalic phase of meal stimulated acid secretion; vagal activity stimulates ECL cells, G cells and parietal cells

47
Q

what happens in the gastric phase of the meal

A

During the gastric phase, gastric distention of the stomach augments vagal output and short peptides, amino acids and calcium, as well as alkaline pH stimulate gastrin release by G cells. Gastrin release is inhibited by a gastric pH <3

48
Q

what are the normal mucosal defense mechanisms against gastric acid (4)

A
  1. the secretion of bicarbonate mucus and phospholipid by gastroduodenal epithelial surface mucous cells;
  2. the epithelial barriers,
  3. mucosal blood flow
  4. epithelial cell renewal

Many of these defense mechanisms are prostaglandin dependent

49
Q

what are the 2 most common causes of peptic ulcer disease

A
  1. H.pylori
  2. NSAIDs
50
Q

less common causes of peptic ulcer disease

A
  1. hypersecretory states
  2. viral infection (CMV, HSV1)
  3. drugs - cocaine
  4. ischaemia
  5. radiation
  6. infiltrative disorders e.g. sarcoidosis
51
Q

how does H.pylori survive in stomach acid (4)

A
  1. urease activity (convert urea to ammonia)
  2. motility
  3. microaerophilic properties
  4. proteases (digest protective mucus)
52
Q

how does H.pylroi damage gastric mucosa

A
  1. production of ammonia
  2. proteases
  3. lipases
  4. mucinates
53
Q

6 physiological changes with hypovolaemia

A
  1. tachycardia
  2. peripheral shut down
  3. hypotension
  4. postural drop may be evident (BP)
  5. confusion
  6. oliguria

nb. BP may be well preserved in young and fit

54
Q

what is the Glasgow blatchford score

A

stratifies upper GI bleeding patients who are ‘low-risk’ and candidates for outpatient management

55
Q

what is portal hypertensive bleeding

A

a spectrum of conditions encompassing oesophageal, gastric and ectopic varies, and portal hypertensive gastropathy

56
Q

what value is portal venous pressure normally

A

5-10mmHg

57
Q

how do oesophageal varices arise

A

the gradients between portal venous pressure and ICV pressure is >10mmHg (normally 3-7mmHg) due to a rise in portal venous pressure -> blood flowing through the hepatic portal system is redirected from the liver into areas with lower venous pressures -> collateral circulation develops in the lower esophagus, abdominal wall, stomach, and rectum -> The small blood vessels in these areas become distended, becoming more thin-walled, and appear as varicosities

58
Q

variceal haemorrhage mgx (7)

A
  1. resusitation and supportive care;
  2. blood transfusion
  3. terlipressin or somatostatin analogue - give at presentation if suspected bleed
  4. prophylactic abx - intravenous ceftriaxone given immediately
  5. endoscopic variceal band ligation
  6. balloon tamponade (emergency holding measure) or Danis stent
  7. transjugular intrahepatic portosystemic shunt (TIPSS)
59
Q

what does splanchnic circulation refer to

A

blood flow tot he abdominal GI organs, including stomach, liver, spleen, pancreas, small intestimes, large intestines - comprises of the coeliac artery, SMA and IMA

60
Q

why must abx be given for variceal haemorrhages

A

bacteraemia and subsequent sepsis is very common

61
Q

secondary prevention of variceal haemorrhages

A
  1. treat liver disease
  2. variceal obliteration
  3. drugs - BBs (carvediol)
  4. determine cause of portal hypertension
62
Q

complications of balloon tamponade for variceal haemorrhages (2)

A
  1. aspiration
  2. mucosal necrosis
63
Q

what is transjugular intrahepatic portosystemic shunt (TIPSS)

A

a mgx for variceal hamorrhages that shunts blood from the portal vein to the hepatic vein - definative treatment for bleeding gastric varices

64
Q

transjugular intrahepatic portosystemic shunt complications (6)

A
  1. procedural/technical fault
  2. infection
  3. stent occlusion
  4. rebleeding
  5. portal systemic shunting
  6. encephalopathy
65
Q
A

3A week 4 - HPB, malabsoprtion and EDs (3 decks)

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