Upper GI conditions Flashcards
Causes of upper GI bleed
Ulcers
Mallory weiss tear
oesophageal varices
malignancy
Duodenal + gastric ulcer presentation
DU = worse at night, more common.
Worse 2-5hrs after meals, alleviated by eating
GU = epigastric pain, N+V, exacerbated by eating
Investigations for ?ulcers
Endoscopy (OGD) - biopsies sent for histology is diagnostic
CLO urease H pylori test (carbon 13 urea breath test)
Bloods
Management of ulcers
Medical management with PPIs for 6-8 weeks
H pylori eradication if positive = metronidazole + clarithromycin + PPI for 7 days
Surgery for perforation or Zollinger Ellison syndrome
Repeat endoscopy
Causes of peptic ulcers
H pylori NSAIDs Aspirin Alcohol Steroids Zollinger-Ellison syndrome -severe peptic ulcer disease, gastric acid hypersecretion + gastrinoma
Red flags for peptic ulcers
ALARMS Anaemia Lost weight Anorexia Recent rapid onset Malaena Swallowing difficulties
Indications for urgent upper GI endoscopy
New onset dysphagia >55 y/o with weight loss + abdo pain/ reflux/ dyspepsia
New onset dyspepsia not responding to PPI
Management of acute GI bleed
ABCDE
Transfusion with blood, platelets + clotting factors
Variceal bleeding = terlipressin, abx, TIPS
Endoscopy
Varcieal bleeding = endoscopic injection of N-butyl-2-cyanoacrylate
Non variceal bleedong = mechanical method, thermal coagulation or fibrin with adrenaline
High dose PPI therapy
What scores are used to assess upper GI bleeding?
Blatchford at first assessment
Rockall after endoscopy
GI bleeds in pts on NSAIDs, aspirin + clopidogrel
Continue low dose aspirin
Stop NSAIDs during acute phase
Discuss risk of clopidogrel
How are upper GI bleeds prevented in acutely unwell pts?
H2 antagonist or PPI therapy in pts admitted to critical care
Use oral form if possible
What is dyspepsia?
> 4 weeks of upper abdo pain/ discomfort, heartburn, reflux, N+V
Common causes of dyspepsia
GORD, peptic ulcers, functional dyspepsia
Initial management of dyspepsia
Advice on lifestyle
Managing stress, anxiety + depression
Reducing drugs that may cause dyspepsia
Management of persistent (>1 month) dyspepsia
PPI for 1 month of H pylori testing
What test should be used for H pylori?
Carbon 13 urea breath test or stool antigen test
When should a pt with dyspepsia be referred for endoscopy?
Recurrent symptoms despite management
2nd line eradication of H pylori is unsuccessful
What is proven GORD?
Oesophagitis (endoscopy determined) or endoscopy negative reflux disease
RF for GORD
Obesity, trigger foods, smoking, alcohol, coffee, stress
CCB, anticholinergics, theophylline, benzos, nitrates
Pregnancy
How common is Barrett’s oesophagus + oesophageal cancer?
10-15% of GORD get Barretts
1-10% of these develop adenocarcinoma
Management of GORD
Lifestyle, sleeping with head of bed raised
Stopping NSAIDs
Full dose PPI for 4 weeks for GORD + 8 weeks for oesophagitis
Management of refractory GORD
Further 4 weeks PPI
Or add H2 antagonist
When should pts with GORD be referred for endoscopy
Refractory to treatment, or unexplained
Associated with RF for Barrett’s
Complications of peptic ulcers
Hemorrhage, perforation, gastric outlet obstruction
