upper GI bleeding

Question 1

what is upper GI bleeding defined as ?

Answer 1

bleeding that occurs proximal to the ligament of Treitz

Question 2

where may upper GI bleeding originate from ?

Answer 2

oesophagus stomach and duodenum

Question 3

what is the most common cause of upper GI bleeding ?

Answer 3

Peptic ulcer disease

Question 4

what are the oesophageal causes of upper GI bleeding ?

Answer 4

Mallory-Weiss Syndrome
Varicies
Oesophagitis
Malignancy

Question 5

what are Mallory-Weiss ?

Answer 5

longitudinal tears in the mucosa in the gastro-oesophageal junction

Question 6

what are the most common cause of bleeding in the duodenum ?

Answer 6

ulcers

Question 7

where are malignant ulcers found in the stomach ?

Answer 7

greater curvature

Question 8

what is the management if there is ongiong bleeding due to Mallory-weiss tears ?

Answer 8

oesophageal clips

sclerotic agents

Question 9

what are the causes of Mallory-weiss syndrome ?

Answer 9

alcoholism
retching
coughing
vomiting

Question 10

what are varicies ?

Answer 10

dilated submucosal veins

Porto-systemic shunts

Question 11

what are varicies a consequence of ?

Answer 11

portal hypertension

Question 12

what is the most common cause of oesophagitis ?

Answer 12

gastro-oesophageal reflux disease
long standing nasogastric tube
chemical injury
alcohol abuse

Question 13

what are the causes of gastritis ?

Answer 13

h.pylori
NSAIDS
Crohn’s disease
Pernicious anemia

Question 14

what are the causes of duodenitis ?

Answer 14

homa homa el causes of gastritis

Question 15

how do we classify bleeding in peptic ulcers ?

Answer 15

Forrest's classification 
Ia jet arterial bleeding
Ib oozing
IIa visible vessel 
IIbadherence clot
IIc low risk of bleeding
III low risk of bleeding

Question 16

what criteria can be used for classification of the site of the peptic ulcer ?

Answer 16

Modified Johnson

Question 17

what are dieulafoy lesion ?

Answer 17

an abberant large artery in the submucosa of either the stomach or the duodenum that bleeds

Question 18

when can a patient present with an aorto-enteric fistula ?

Answer 18

after repair of abdominal aortic aneurysm

Question 19

what drugs must you be wary off in a bleeding patient ?

Answer 19

Thrombolytics ( clopodigrel , Aspirin)
anticoagulants
ortho or neuro drugs ( NSAIDS)

Question 20

how can we remove contents of the stomach ?

Answer 20

using nasogastric lavage

cold saline to induce vasoconstriction

Question 21

what is the management for non variceal bleeding ?

Answer 21

mechanical clipping 
thermal sealing 
injection approach 
hemospray 
local adrenaline

Question 22

how does theraml sealing work ?

Answer 22

uses coagulative necrosis to seal the bleeding

Question 23

if endoscopy and pharmacological approaches didn’t work what can be done ?

Answer 23

trans-catheter arterial embolization

Question 24

what if trans-catheter arterial embolization doesnt work?

Answer 24

gastrectomy

Question 25

how do we manage variceal bleeding ?

Answer 25

terlipressin: venoconstriction
prophylactic ab 
band ligation 
sclerotherapy 
TIPS

Question 26

when do we use sclerotherapy ?

Answer 26

when band ligation fails

Question 27

when do use octeotride/somatostatin ?

Answer 27

in active bleeding attack

Question 28

what substance can be used to “superglue” gastric varicies?

Answer 28

N-butyl-2-cyanoacrylate

Question 29

what is the purpose of TIPS ?

Answer 29

to decrease the pressure in the splenic circulation