Upper Gi Bleeding Flashcards
Q1: What is upper gastrointestinal (GI) bleeding?
A: Bleeding from the esophagus, stomach, or duodenum, characterized by hematemesis and melena.
Q2: What are the major causes of lower GI bleeding?
A: Diverticulosis, angiodysplasia, inflammatory bowel disease, colorectal carcinoma, and hemorrhoids.
Q3: What is the Rockall Score used for?
A: Estimating the risk of rebleeding or death in patients with upper GI bleeding.
Q4: What percentage of lower GI bleeding cases stop spontaneously?
A: More than 75%.
Q5: What is the main cause of esophageal varices?
A: Portal hypertension.
Q6: Name a medication that can cause GI ulcers and hemorrhage.
A: Aspirin and NSAIDs
Q7: What are some risk factors for lower GI bleeding?
A: Low fiber diet, obesity, physical inactivity, advancing age, and NSAID use.
What increases the risk of rebleeding and mortality in GI bleeding?
A: Age, co-morbidities, shock, and active bleeding ulcers.
What symptom often suggests chronic GI bleeding?
A: Iron-deficiency anemia.
What is the significance of red signs on varices?
A: They indicate an increased risk of bleeding.
What are red flag symptoms of lower GI bleeding?
A: Weight loss, change in bowel habits, iron-deficiency anemia, and abdominal masses.
What symptom is associated with diverticulitis?
.
A: Painful cramps in the lower abdomen
What are signs of shock in GI bleeding?
A: Pallor, cold extremities, systolic BP < 100 mmHg, and pulse > 100/min.
What are typical symptoms of angiodysplasia?
A: Lower-grade bleeding, but can lead to massive hemorrhage if veins rupture.
How does upper GI bleeding differ from lower GI bleeding in stool appearance?
A: Upper GI bleeding can cause melena, while lower GI bleeding often leads to bright red blood.
Q16: What diagnostic test is preferred for detecting lower GI bleeding?
A:.
Colonoscopy
What is a hallmark feature of diverticular bleeding?
A: Painless rectal bleeding.
What test is recommended for diagnosing H. pylori in peptic ulcer disease?
.
A: Antral biopsy during endoscopy
When is video capsule endoscopy used?
A: For detecting bleeding in the small bowel when other endoscopies fail.
What does an elevated BUN-to-creatinine ratio indicate?
A: Likely upper GI bleeding.
What is the first step in managing a significant GI bleed?
A: Restoring blood volume through transfusion and IV fluids.
When should urgent endoscopy be performed for upper GI bleeding?
A: Within 24 hours for significant bleeding, or immediately for varices.
What are the indications for blood transfusion in GI bleeding?
A: Shock and hemoglobin < 10 g/dL with active bleeding.
How are bleeding varices typically treated during endoscopy?
A: With banding or injection of a sclerosing agent.
What is the role of proton pump inhibitors (PPIs) in GI bleeding?
A: They reduce rebleeding rates in ulcer patients.
What is a Mallory-Weiss tear?
A: A mucosal tear at the gastroesophageal junction caused by sudden increased abdominal pressure.
What is the main symptom of a Mallory-Weiss tear?
.
A: Hematemesis, often after vomiting
What is angiodysplasia?
A: Tortuous, dilated veins in the colon, often causing bleeding.
What is the treatment for diverticulitis?
A: Antibiotics for uncomplicated cases, and surgery for complications.
How is chronic gastrointestinal bleeding often treated?
A: By addressing the underlying cause and administering oral iron.
What is dual endoscopic therapy for peptic ulcers?
A: Combining epinephrine injection with thermal coagulation or clipping.
Why is banding preferred over sclerotherapy for varices?
A: It is more effective in reducing rebleeding with fewer complications.
What is the treatment of choice for gastric varices?
A: Injection of tissue glue.
What findings on endoscopy suggest a high risk of rebleeding?
A: Spurting artery, active oozing, and exposed blood vessels.
What is the role of thermal therapy in chronic GI bleeding?
A: It treats vascular lesions in the small bowel.
What is a Transjugular Intrahepatic Portosystemic Shunt (TIPS)?
A: A stent placed to reduce portal hypertension, used if other therapies fail.
What is the mortality rate of variceal hemorrhage in severe liver disease?
A: Up to 50% in Child’s grade C liver disease.
How does somatostatin help in variceal bleeding?
A: It reduces bleeding by decreasing splanchnic blood flow.
What is the prognosis for GI bleeding overall?
.
A: Mortality rates range from 5–12%, depending on age and co-morbidities
What therapy reduces portal pressure in variceal bleeding?
A: Non-selective beta-blockers like propranolol.
What fluids are initially used while awaiting blood transfusion?
A: Plasma expanders or 0.9% saline.
Why is hemoglobin not immediately a reliable indicator of bleeding severity?
A: Anemia does not develop immediately due to lack of hemodilution
What is the treatment for active lower GI bleeding caused by angiodysplasia?
A: Colonoscopic coagulation, or segmental resection if bleeding persists.
When is surgery indicated for diverticular disease?
A: For recurrent hemorrhage or failure to respond to medical treatment.
What are the two main forms of management for acute variceal bleeding?
A: Endoscopic techniques (banding or sclerotherapy) and vasoconstrictor therapy.
What is the most common worldwide cause of chronic GI bleeding?
.
A: Hookworm infection
What diagnostic tests are used to investigate chronic GI bleeding?
A: Upper and lower GI endoscopies, duodenal biopsies, and video capsule endoscopy.
What should be excluded in cases of chronic bleeding with iron deficiency anemia?
A: Cancer, especially stomach or right colon cancer, and celiac disease.
When should celiac axis and mesenteric angiography be considered?
A: When other investigations fail to reveal the bleeding source.
What maintenance treatment may be required in chronic bleeding?
A: Regular transfusions if anemia is transfusion-dependent.
What are common complications of diverticulitis?
A:.
Abscess, fistula, perforation, peritonitis, and intestinal obstruction
What is the first diagnostic test for suspected diverticulitis?
A: CT scan.
What dietary recommendation can help prevent diverticulosis complications?
A: A high-fiber diet.
How does diverticulitis differ from diverticulosis?
A: Diverticulitis involves inflammation or infection, while diverticulosis typically has no symptoms.
What are typical symptoms of diverticulitis?
A: Fever, abdominal pain, vomiting, and altered bowel habits.
What is the first-line treatment for a bleeding peptic ulcer with active bleeding?
A: Endoscopic therapy with dual hemostatic methods.
What long-term therapy is recommended after treating H. pylori in ulcers?
A: Proton pump inhibitor therapy for 4 weeks to ensure ulcer healing.
Q58: What should be done if H. pylori eradication fails in peptic ulcer patients?
A: Consider long-term acid suppression therapy.
Why should gastric histology always be performed in ulcers?
A: To exclude malignancy.
What is the role of surgery in recurrent bleeding ulcers?
A: Ligation of the bleeding vessel if medical and endoscopic therapies fail.
Why has the mortality from GI hemorrhage not decreased significantly over the years?
A: Due to an aging population with more co-morbidities.
How effective is early therapeutic endoscopy for upper GI bleeding?
.
A: It diagnoses the cause in over 80% of cases and reduces rebleeding rates
What percentage of lower GI bleeding originates from the colon?
A: 90%.
What is the typical mortality rate for lower GI bleeding?
A: Less than 5%.
