Upper GI Bleeding

Question 1

Most frequently encountered aetiologies for UGIB ?

Answer 1

Peptic ulcer disease (35-50%)
o Oesophagitis (5-15%)
o Varices (5-14%)
o Mallory-Weiss tear (15%)

Question 2

Gold standard for diagnosis and therapy of Upper GI bleed?

Answer 2

Endoscopy

Question 3

• Coffee ground – slower, intermittent bleed?

Answer 3

Peptic ulcer disease

Question 4

• Brisk haematemesis - Fresh bleed

Answer 4

variceal bleed

often these patients have portal hypertension and liver disease

Question 5

• UGIB starting after vomiting or retching?

Answer 5

Mallory Weiss tear

Question 6

if patient has malaena - what is your first step?

which patients are often mistaken for having malaena?

Answer 6

DRE (digital rectal exam) and faecal occult blood

bismuth containing products (pepto-bismul) and iron supplements - both make dark appearing stools

Question 7

if someone has fresh red blood vomit with chronic liver disease/Hx of alcoholism - suggestive of?

Answer 7

variceal bleed (oesophageal varices)

Question 8

if someone has UGIB and Hx of IVDU, alcohol use or underlying liver disease - suggestive of?

Answer 8

Variceal bleed (oesophageal varices)

Question 9

conditions causing portal hypertension predispose someone to?

Answer 9

oesophagal variceal bleed

Question 10

coffee ground/haematemesis w/ Hx of NSAID use or past ulcers?

brisk haematemesis w/ Hx of chronic liver disease/alcohol/IVDU?

UGIB malaena with dysphagia/odynophagia?

haematemesis following retching?

Answer 10

peptic ulcer disease

oesophageal varices

oesophagitis

mallory-weiss tear

Question 11

why do you get oesophageal varices?

Answer 11

venous dilatation

due to increase in portal pressures

Question 12

Tx of oesophageal varices?

after 1st bleed - 60% rebleed after 1st year - what do you do prophylactically?

Answer 12

endoscopic banding (oesophageal) 
scleropathy (gastric) 

give B-blockers or repeat banding