Upper GIT bleeding Flashcards
What Variables Adversely Affect Prognosis in a Patient with an Upper GI Bleed?
Increasing age (>65 years old)
* Altered mental status
* Low Albumin
* INR greater than 1.5
* Shock on presentation (systolic blood pressure <90 mmHg)
where are oesoph varices located
distal 1/3 oesoph
submucosal region
what causes oesoph varices?
Portal hypertension
The primary venous
drainage of the esophagus is via the esophageal veins that empty into the superior vena cava.
However,
distal veins within the submucosa empty into the left
gastric vein, which normally drains into the portal vein. In the
presence of cirrhosis and impeded portal flow through the liver, the portal vein has much more difficulty
draining its blood into the scarred liver. Blood is forced to flow in a retrograde direction, under high
pressure, toward the tributaries of the portal vein, leading to varices
Defence mechanisms within the stomach
prostaglandins,
bicarbonate, and somatostatin-reduce inflammation
affect of alcohol on gastric acid secretion
low doses increase secretion
affect of NSAIDs on stomach lining
inhibit COX-1 and C0X-2 pathways, reduce production of prostaglandins
types of chronic gastritis
Type A: more autoimmune, fundus dominant. Leads to pernicious anaemia (autoantibodies towards parietal cells-megaloblastic anaemia and Vit B12 def)
Type B: antrum (H pylori causes it), MORE COMMON, causes PUD, gastric cancer and MALT
Dieulafoy’s Lesion
Rare cause of acute upper GI bleed.
This is a congenital dilated submucosal
tortuous artery, often located on the lesser curvature of the stomach that erodes the gastric epithelium
in the absence of a primary ulcer and is thus exposed to gastric secretions that may lead to massive
upper GI hemorrhage.
What Are the Important Anatomic Correlations for Peptic Ulcer Disease?
The branches of the celiac trunk may be subject to erosion leading to severe hemorrhage if an ulcer
penetrates through the gastrointestinal mucosa and into the vessel.
upper vs lower GIT bleeding
LGIT bleeding as ligament of Treitz down (distal intraperitoneal duodenum)
What Are the Indications for Surgery in a Patient with an Upper GI Bleed
Failure of endoscopic therapy (usually after two attempts)
* Persistent hemodynamic instability despite aggressive resuscitations
* Cardiovascular disease with predictive poor response to hypotension
* Hemorrhagic shock
What Happens to the Urea/Creatinine Ratio During an Upper GI Bleed (UGIB)
The Urea/creatinine ratio increases. This increase is a result of absorption of degraded blood products
(protein) during intestinal transit and prerenal azotemia secondary to hypovolemia. Urea/creatinine ratio
correlates positively with the likelihood of an UGIB, and isolated increases in Urea can be a subtle
indicator of an UGIB
