Upper GI bleed Flashcards
What are the symptoms of peptic ulcer disease?
hx of NSAID use (often with concomitant use of corticosteroids) or past ulcers is common; ingestion of food often transiently improves abdominal pain; coffee-ground emesis and haematemesis are very common
What are the signs of peptic ulcer disease?
mid-epigastric tenderness to palpation
What first line investigations would you consider in peptic ulcer disease?
upper GI endoscopy (OGD): direct visualisation of the ulcer
What other investigations would you consider in peptic ulcer disease
barium radiography: barium within an ulcer crater
Helicobacter pylori serology or breath test: positive for H pylori
What are the symptoms of oseophageal varies?
any hx of intravenous drug use that could lead to chronic hepatitis, chronic alcoholism, or cirrhosis should immediately arouse suspicions of portal hypertension and thus varices; variceal bleeds often lead to brisk haematemesis
What are the signs of oesophageal varices?
stigmata of chronic liver disease are often present, e.g., jaundice, hepatomegaly, splenomegaly, ascites
What first line investigations would you consider in oesophageal varices?
upper GI endoscopy (OGD): direct visualisation of the varices
What other investigations would you so in oesophageal varices?
CT scan/portal angiography: can show collateral veins and recanalised umbilical vein
transjugular intrahepatic portosystemic shunt (TIPS) procedure: to decompress intractable oesophageal variceal bleeding
What are the symptoms of oesophagitis?
often seen in the context of GORD; sometimes associated with dysphagia or odynophagia; hx may or may not include chronic heartburn; patients sometimes mention a globus sensation; hoarseness can also be present; many patients who present with melaena and who are suspected of peptic ulcer disease will actually be found to have oesophagitis on endoscopy
What are the signs of oesophagitis?
reproducible pain can be demonstrated on swallowing
What first line investigations would you consider in oesophagitis?
upper GI endoscopy (OGD): direct visualisation of oesophageal irritation/inflammation
What are the symptoms of mallory-weiss tear?
classically, patients note haematemesis following retching or vomiting, but any increase in intra-oesophageal pressure (e.g., from seizures, hiccups, or straining) can cause a tear; some tears develop spontaneously; alcohol use, advanced age, and presence of hiatal hernias are common underlying features
What are the signs of mallory-weiss tear?
bleeding is sometimes accompanied by mid-epigastric or retrosternal pain
What first line investigations would you do for mallory-weiss tear?
upper GI endoscopy (OGD): direct visualisation of intramural dissections
What are the symptoms of upper GI tumours?
constitutional symptoms such as involuntary weight loss or night sweats
