upper GI bleeding Flashcards
what is upper GI bleeding defined as ?
bleeding that occurs proximal to the ligament of Treitz
where may upper GI bleeding originate from ?
oesophagus stomach and duodenum
what is the most common cause of upper GI bleeding ?
Peptic ulcer disease
what are the oesophageal causes of upper GI bleeding ?
Mallory-Weiss Syndrome
Varicies
Oesophagitis
Malignancy
what are Mallory-Weiss ?
longitudinal tears in the mucosa in the gastro-oesophageal junction
what are the most common cause of bleeding in the duodenum ?
ulcers
where are malignant ulcers found in the stomach ?
greater curvature
what is the management if there is ongiong bleeding due to Mallory-weiss tears ?
oesophageal clips
sclerotic agents
what are the causes of Mallory-weiss syndrome ?
alcoholism
retching
coughing
vomiting
what are varicies ?
dilated submucosal veins
Porto-systemic shunts
what are varicies a consequence of ?
portal hypertension
what is the most common cause of oesophagitis ?
gastro-oesophageal reflux disease
long standing nasogastric tube
chemical injury
alcohol abuse
what are the causes of gastritis ?
h.pylori
NSAIDS
Crohn’s disease
Pernicious anemia
what are the causes of duodenitis ?
homa homa el causes of gastritis
how do we classify bleeding in peptic ulcers ?
Forrest's classification Ia jet arterial bleeding Ib oozing IIa visible vessel IIbadherence clot IIc low risk of bleeding III low risk of bleeding
what criteria can be used for classification of the site of the peptic ulcer ?
Modified Johnson
what are dieulafoy lesion ?
an abberant large artery in the submucosa of either the stomach or the duodenum that bleeds
when can a patient present with an aorto-enteric fistula ?
after repair of abdominal aortic aneurysm
what drugs must you be wary off in a bleeding patient ?
Thrombolytics ( clopodigrel , Aspirin)
anticoagulants
ortho or neuro drugs ( NSAIDS)
how can we remove contents of the stomach ?
using nasogastric lavage
cold saline to induce vasoconstriction
what is the management for non variceal bleeding ?
mechanical clipping thermal sealing injection approach hemospray local adrenaline
how does theraml sealing work ?
uses coagulative necrosis to seal the bleeding
if endoscopy and pharmacological approaches didn’t work what can be done ?
trans-catheter arterial embolization
what if trans-catheter arterial embolization doesnt work?
gastrectomy
how do we manage variceal bleeding ?
terlipressin: venoconstriction prophylactic ab band ligation sclerotherapy TIPS
when do we use sclerotherapy ?
when band ligation fails
when do use octeotride/somatostatin ?
in active bleeding attack
what substance can be used to “superglue” gastric varicies?
N-butyl-2-cyanoacrylate
what is the purpose of TIPS ?
to decrease the pressure in the splenic circulation
