Upper GI Conditions**** Flashcards
ONLY DO UPPER GI BLEED FOR EMERGENCIES
Upper GI bleed:
Causes:
- How does PUD cause an upper GI bleed?
- Diseases with inflammation?
- Usually, caused by alcohol disease?
- Found after severe vomiting?
- One more obvious thing
Erodes into a blood vessel - typically posterior duodenal ulcer
Oesophagitis
Gastritis
Duodenitis
Oesophageal or gastric ulcers
Mallory-Weiss tear following severe vomiting
Upper GI cancer
Upper GI bleed:
What questions should you ask in history?
Post GI bleeds Dyspepsia Known liver disease Dysphagia Vomiting Weight loss
Upper GI bleed - S+S
What 2 ways can the pain present?
Haematemesis - What does it look like if it is active and if it is settled?
What is melena? What can it be also caused by? - 2
What systemic presentation might there be?
Epigastric pain
Diffuse Abdo pain
Red if active
Coffee-ground I settled
Black and foul-smelling stool
Ascending colon cancer and iron tablets
Shock - hypovolaemia
Upper GI bleed - gastro-oesophageal varices:
What is it?
Cause?
Management - surgical and medical
Submucosal venous dilatation secondary to increased portal pressures
CLD
Endoscopic banding/sclerotherapy
Beta-blockers - Lowers HR, therefore, lower BP meaning reduced risk of bursting veins
Upper GI bleed - Portal Hypertension
Pre-hepatic cause - 1
Intra-hepatic cause - 1 example
Post-hepatic cause - 2
Risk factors of variceal bleeds - 4
Thrombosis in portal/splenic vein
Cirrhosis
Right HF
Constrictive Pericarditis
Increase portal pressure
Variceal size
Endoscopic features of variceal wall
Advanced liver disease
Upper GI bleed - Investigations:
Bloods:
- Why do the haemoglobin?
- What should be done for surgery?
- What can be done to assess liver function? - 2
- Why do the urea?
Imaging
May be normal before fluid resuscitation
Crossmatch
Coagulation and LFT’s
Erect CXR and Abdo CXR
CT abdo-chest
Upper GI bleed - Risk Assessment:
What score can be used in the first assessment to see whether intervention is needed?
What score can be used to identify patients at risk of adverse outcome following acute upper gastrointestinal bleeding?
Blatchford score
Rockall score
SO BR - bilirubin
Upper GI bleed - Management - unstable
(1) What to do if unstable?
(2) What 2 drugs can be given for non-variceal bleeds?
- one reduces urination to maintain blood vol and the
- other is a vasoconstrictor which is also a statin?
- what drug should be added if it is a variceal bleed?
Resuscitate - ABCDE - Oxygen, fluids and consider transfusion
Terlipressin (ADH analogue)
Somatostatin
Prophylactic antibiotics
Upper GI bleed - Management - unstable
(3) What should the patient be instructed to do?
Endoscopic diagnosis and repair
- What is done for a non-variceal bleed?
- What is done for oesophageal varices?
- What is done for a gastric bleed?
Nil by mouth
Endoscopic diagnosis and repair
Clipping OR Thermal coagulation with adrenaline
Band ligation
Cyanoacrylate (glue)
Upper GI bleed - Management - unstable
(4) If endoscopy fails:
- What surgery can be done if variceal?
- TIPS can also be done if variceal
(5) What medication should be given for PUD bleeding? post-endoscopy?
Upper GI bleed - Management
- What should be done if the patient is stable?
Suture ligation
Transjugular intrahepatic portosystemic shunt
PPI - Initially IV to increase gastric pH and aid ulcer healing
- THEN PO as part of H.pylori eradication or as a protective measure if restarting NSAIDs
Endoscopy
Achalasia:
What is it?
Presentation - 2
Failure of smooth muscle relaxation in the lower oesophagus due to the impaired nerve supply
Fluid regurgitation
Aspiration pneumonia
Achalasia:
Investigations:
What is the standard investigation needed?
What sign do you see on Barium swallow on XR?
What can be done to measure the pressure in the upper and lower oesophageal sphincters?
Upper GI endoscopy
Bird peak sign - look at pics
Oesophageal manometry
Achalasia - Management - Medical
Why do you give them CCB’s? Give one example
What does botulinum toxin do and why is it given?
Causes muscle relaxation - nifedipine
Causes relaxation via injection into the LOS
Achalasia - Management - Interventional Treatment
First-line invasive treatment?
What is cardiomyotomy? - Look at pics
Endoscopic (pneumatic) dilatation of LOS
A longitudinal cut of the lower oesophagus and stomach cardia
Relieves the grip of the non-relaxing muscle from the outside
Pharyngeal Pouch:
What is another name for it?
What is it?
Zenker’s diverticulum
Pouch at anatomically weak point of the pharynx
Killian dehiscence
