UGIB

Question 1

whats UGIB

Answer 1

its blood loss within the intraluminal gastrointestinal tract from any location between the upper esophagus to the duodenum at the ligament of treitz

Question 2

which GI bleed is more common

Answer 2

UGIB - accounting for 70% of all gastrointestinal bleeding

Question 3

causes of UGIB can be grouped into what

Answer 3

local and systemic causes

Question 4

the local causes are best considered how

Answer 4

anatomically

Question 5

what are the local causes of UGIB

Answer 5

Esophagus- esophagitis, varices, esophageal tumors, mallory-weiss syndrome

Stomach- erosive gastritis, gastric ulcers, gastric tumors, isolated gastric varices, dieulafoy’s lesion

Duodenum- severe duodenitis, duodenal ulcers, duodenal erosion (pancreatic tumor)

Question 6

systemic causes of UGIB are best considered by

Answer 6

bleeding diathesis

Question 7

what are the systemic causes of UGIB

Answer 7

-hemophilia, leukemia, thrombocytopenia
-hereditary hemorrhagic telangiectasia
-anticoagulant therapy

Question 8

what causes portal hypertension

Answer 8

obstruction in the portal tree i.e.
-prehepatic
-hepatic
-post hepatic

Question 9

what is the commonest cause of portal hypertension

Answer 9

cirrhosis

Question 10

what is the commonest cause of portal hypertension in malawi

Answer 10

schistosomiasis

Question 11

what are the portosystemic shunts in PHTN

Answer 11

1. left gastric vein and esophageal veins
2. superior and inferior rectal veins
3. obliterated umbilical vein and epigastric veins
4. retroperitoneal and diaphragmatic anastomoses

Question 12

what are the largest and clinically the most important connections in the portosytemic shunts in PHTN

Answer 12

left gastric vein and esophageal veins

Question 13

what is the most serios complication of PHTN

Answer 13

bleeding esophageal veins

Question 14

what signs do you see in PHTN

Answer 14

• splenomegaly because of the portal congestion
• umbilical vein recanalization which leads to caput medusa
• ascites
• anorectal varices

Question 15

what is the splenomegaly in PHTN often associated with

Answer 15

hypersplenism

Question 16

what causes PUD

Answer 16

• when there is an imbalance between acid secretion and mucosal defense
• helicobacter pylori infection
• non steroidal anti inflammatory
• cigarette smoking
• acid hypersecretion

Question 17

which ulcers do h. pylori mainly cause

Answer 17

Duodenal ulcers- 90-95% then second gastric ulcers 70-90%

Question 18

how do PUD cause death

Answer 18

by hemorrhage ( however new studies are showing that septic shock is becoming the leading cause due to the leakage of the gastric contents)

Question 19

whats the leading cause of UGIB worldwide

Answer 19

PUD, which is then followed by esophagitis and erosive disease

Question 20

in africa what is the leading causes of UGIB

Answer 20

esophageal varices

Question 21

what things could you find in the clinical presentation for UGIB

Answer 21

• dysphagia/ odynophagia (esophagitis +/- ulcer, tumor)
• hematemesis
• abdominal pain (from PUD)
• chronic anemia symptoms ( fatigue, SOB, heart palpitations)
• stigmata of liver disease 9 ascites, cirrhosis, caput medusa, gynecomastia, jaundice, palmar erythema, spider nevi, ecchymosis, leukonychia, finger clubbing, asterixis, fetor hepaticus)
• malena
• dry retching cough (mallory weiss tear)

Question 22

how do you manage UGIB

Answer 22

1. resuscitation
2. accurate diagnosis
3. treatment and control of source of bleeding

Question 23

how to you resuscitate in an UGIB

Answer 23

• Airway, breathing, circulation
• give oxygen
  -put large bore cannula
• commence rapid fluid IV (normal saline)
• assess for shock

Question 24

how will majority of UGIB stop

Answer 24

spontaneously

Question 25

what investigation do you do in an UGIB

Answer 25

• FBC and grouping and cross match
• LFTs
• U&Es
• ABGs
• UGI endoscopy