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GI > GI bleed > Flashcards

GI bleed Flashcards

1
Q

Causes of upper GI bleed?

A 
Peptic ulcer
Gastritis
Varices
Mallory weiss
Malignancy
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2
Q

What is an erosion?

A

Damage to mucosal layer

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3
Q

What is an ulcer?

A

Damage beyond lamina propria

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4
Q

Causes of peptic ulcers?

A 
H. Pylori
NSAID/aspirin
Gastric ischemia
Zollinger-Ellison
Bisphosphonates
Cytomegalovirus (in HIV)
Crohn's disease 
Idiopathic
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5
Q

What is Zollinger-Ellison syndrome?

A

Gastric acid hyper secretion caused by a gastric secreting neuroendocrine tumour

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6
Q

How does H. Pylori cause ulcer?

A

Inflammatory response to pathogen breaks down mucosal lining, disrupts tight junction and induces gastric cell death

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7
Q

How do NSAIDs cause ulcers?

A

Inhibition of COX enzyme which reduces protective prostaglandin synthesis and H+ ion trapping

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8
Q

Gastric acid secretion in duodenal ulcer vs gastric ulcer

A

Hypersecretion in duodenal, normal or low in gastric

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9
Q

Anterior duodenal ulcer

A

Perforation - present with shock+peritonitis

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10
Q

Posterior duodenal ulcer

A

Bleed - gastroduodenal artery lies posterior

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11
Q

How does H.Pylori cope with acidic conditions?

A

Regulates urease activity to produce ammonium to neutralise protons, moves to basal layer where pH is more neutral

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12
Q

Why increased bleeding risk with NSAIDs

A

Anti-platelet effect

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13
Q

Symptoms of peptic ulcer?

A 
Abdominal pain
Belching
Nausea/vomiting
Poor appetite
Weight loss
Haematemesis
Malena
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14
Q

Relationship with abdominal pain and eating in peptic ulcers?

A

Duodenal - improves on eating, worse at night

Gastric - worsens on eating

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15
Q

What is behcet’s syndrome

A

Blood vessel inflammation throughout body - affects eyes, mouth, skin, genitals, joints, digestive system and brain - autoimmune

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16
Q

What is a mallory weiss tear?

A

Secondary to severe retching or vomiting - occurs in lower oesophagus
Associated with alcoholism and eating disorders

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17
Q

What is boerhaave syndrome

A

Full thickness mallory weiss tear

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18
Q

What is oesophagitis?

A

Inflammation of the oesophagus

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19
Q

Causes of oesophagitis?

A 
Reflux
Surgery
Medication
Hernia
Radiation 
Food bolus impaction
20
Q

Types of oesophageal carcinoma?

A

Squamous cell - central 1/3 and adeno distal 1/3

21
Q

Cause of adenocarcinoma

A 
Secondary to Barrett oesophagus
Obesity
Alcohol
Tobacco
Hiatal hernia
22
Q

What is Barrett’s oesophagus

A

Metaplasia in response to gastric acid exposure - squamous to columnar

23
Q

Squamous cell risk factors?

A

Alcohol abuse
Poverty
Injury - hot drinks/radiation

24
Q

Presentation of oesophageal cancer

A

70+
Weight loss
Haematemesis
Dysphagia

25
Q

Prognosis of oesophageal cancer?

A

<20% 5 year survival

26
Q

Gastric cancer presentation?

A 
50-60 y/o, 'chronic gastritis' 
Weight loss
Anorexia
Early satiety
Haemorrhage
27
Q

Types of gastric cancer?

A

Intestinal type- bulky/ulcerative with glandular structure caused by increased wnt signalling
Diffuse infiltrative type - permeates the stomach wall causing a desmoplastic reaction - loss of e-cadherin?

28
Q

example pathogenesis of intestinal type

A

H. pylori infection – chronic gastritis – reactive hyperplasia – dysplasia – adenocarcinoma

29
Q

What are oesophageal varices?

A

Dilation of collateral veins in lower oesophagus and gastric cardia due to portal hypertension

30
Q

Causes of portal hypertension

A

PRE - Thrombosis
INTRA - cirrhosis, schistosomiasis, sarcoid, myeloproliferative disease
POST - Budd Chiari syndrome, right ventricular failure, constrictive pericarditis

31
Q

Score to assess rebreeding or mortality from upper GI bleeding?

A

Rockall pre and post endoscopy

32
Q

What does pre-endoscopic Rockall score assess?

A

Age
Evidence of shock
Comorbidities - CHF, IHD, renal/liver failure, malignancy

33
Q

What additional criteria are on post-endoscopic Rockall score?

A

Diagnosis

Major stigmata of recent haemorrhage

34
Q

What are the major stimata of recent haemorrhage?

A

Dark spot - low risk of rebleed

Blood in tract, adherent clot, visible or spurting vessel - high risk of rebleed

35
Q

Non-variceal bleed management

A

PPI infusion
H. Pylori eradication
Endoscopic intervention e.g. clips, glue etc

36
Q

Variceal haemorrhage management

A

Terlipressin - vasopressin analogue to initiate vasoconstriction, platelet aggregation and liver gluconeogenesis

37
Q

H. Pylori eradication?

A

PPI + clarithromycin + amoxicillin/metronidazole

38
Q

Alternative to pre-endoscopic rockall?

A

Glasgow blatchford score

39
Q

Terlipressin consequence?

A

MI

40
Q

Causes of lower GI bleed?

A 
Haemorrhoids
Diverticulitis
IBD
Malignancy
Polyps
Angiodysplasia
Infectious diarrhoea
41
Q

What is Meckel’s diverticulum?

A

Congenital abnormality due to incomplete obliteration of vitelline duct resulting in ileal diverticulum

42
Q

What is diverticular disease?

A

Most common cause of lower GI bleeding, small out-pouches through bowel wall, associated with lack of dietary fibre, inc alcohol consumption, red meat, obesity and NSAIDs

43
Q

Where is colonic angiodysplasia most common?

A

Right colon - risk of bleeding associated with recent anticoagulation

44
Q

What is a Dieulafoy lesion?

A

Large tortuous artery in submucosa which does not undergo normal branching - commonly in duodenum, colon, jejunum and oesophagus - can bleed

45
Q

Pathogens causing rectal bleeding?

A

Enterohemorrhagic escherichia
Salmonella
Histoplasma
Cytomegalovirus

46
Q

Less common pathogens for rectal bleeding?

A 
Campylobacter
Clostridium
Shigella
Yersinia
Cryptosporidium
Herpes
47
Q

Other cause of lower GI bleed?

A

Massive upper GI haemorrhage

GI (9 decks)

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