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
