Upper GI bleed Flashcards
Source of bleed if melena?
Above ligament of treitz
3 most common causes upper gi bleed?
• oesophageal or gastric varices from portal hypertension
• peptic ulcer disease
• gastric erosions from steroid or NSAID use
Name 7 less common causes upper gi bleed
• Mallory Weiss oesophageal tear
• malignant ulcer
• gist (tumour)
• uraemic gastritis
• Dieulafoy’s disease (genetic AV malformation)
. Curling or stress duodenal ulcer, especially after burns
• cushings gastric ulcer from raised ICP with head injury
Name 5 rare causes upper gi bleed
• aorto -enteric fistula from AAA especially after open repair
• duodenal varices
• haemobilia
• haemosuccus pancreaticus usually from ruptured splenic or pancreatic artery pseudo aneurysm into pancreatic pseudocyst or pancreatic duct in background of pancreatitis
. Telangestasia Av malformation
Name 9 causes haemobilia
• Iatrogenic instrumentation: ercp sphincterotomy, eus needle biopsy head pancreas, instrument biliary tree eg stent, cholecloscope, percut liver needle biopsy, ptc
• iatrogenic injury during hepato-biliary surgery
• trauma to liver, biliary tree, head pancreas
• neoplastic lesions: hepatic, cholecystic, choledocal
• hepatobiliary inflammation/infection
• hepato biliary ascariasis (parasite)
• gallstones
• haemosuccus pancreaticus
• severe coagulopathy
Management of bleeding gastric erosions (erosive gastritis)? (7)
• ATLS, resus for haemorrhagic shock
• NGT to confirm and suck blood
• Gastric acid suppression with PPI or H2RA
• mucosal protection with sucralfate (ulsanic)
• replace blood if indicated by high volume Haematemesis with shock, or low Hb after initial resuscitation
• May need to do gastric lavage to prepare for gastroscope or could use ice cold lavage to induce vasoconstriction (controversial)
• Disease is self-limiting on withdrawal causative agent eg steroids, NSAIDs
Clinical features bleeding. erosive gastritis? (4)
• Epigastric pain
• history steroid or nsaid use
• Haematemesis, melena
• haemorrhagic shock
Cause duodenal varices? (2)
• Most commonly due to portal hypertension or portal vein thrombosis, will also have varices elsewhere
• isolated: SMv thrombosis
Imaging Investigations for duodenal varices? (3)
• Diagnose by duodenoscopy extending to d3 or d4
. Contrast CT or MRI to delineate portal or mesenteric vein thromboses
• Ultrasound to determine direction of portal blood flow , limited to proximal portal or splenic Vein
Which locoregional pathologies are associated with duodenal ulcer in d1? (3)
• Generalised/global PHT of all aetiologies
• chronic pancreatitis
• splenoportal thrombosis
Which locoregional pathologies are associated with duodenal ulcer in d2? (4)
• PHT
• chronic pancreatitis
• splenoportal thrombosis
• mesoportal thrombosis
Which locoregional pathologies are associated with duodenal ulcer in d3? (2)
•Mesoportal thrombosis
. Focal mesenteric occlusion
Which locoregional pathologies are associated with duodenal ulcer in d4?
Focal mesenteric occlusion
Name 4 therapeutic uses of angiography in UGI bleed
. Haemostasis of bleeding peptic ulcer or dieulafoy where endoscopic techniques have failed , first line to control bleed from neoplasm,
• haemobilia
• telangiectasia
• haemosuccus pancreaticus
Endoscopic Diagnostic criteria of Dieulafoy’s lesion (3)
• Active arterial spurt or pulsatile streaming through mucosal defect or under normal mucosa
• protruding vessel with or without bleeding through small defect or under normal mucosa
• freshly densely adherent clot with narrow point attachment to small defect or normal mucosa in association with Haematemesis or melena
Define dieulafoy lesion
Prominent large submucosal artery found in proximal stomach within 6 cm of GEJ. May protrude into gut lumen and cause recurrent massive haemmorrhage when overlying mucosa becomes ulcerated
