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GI bleed Flashcards

(47 cards)

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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?

Study These Flashcards
A 
Reflux
Surgery
Medication
Hernia
Radiation 
Food bolus impaction
20
Q

Types of oesophageal carcinoma?

Study These Flashcards
A

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

21
Q

Cause of adenocarcinoma

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

What is Barrett’s oesophagus

Study These Flashcards
A

Metaplasia in response to gastric acid exposure - squamous to columnar

23
Q

Squamous cell risk factors?

Study These Flashcards
A

Alcohol abuse
Poverty
Injury - hot drinks/radiation

24
Q

Presentation of oesophageal cancer

Study These Flashcards
A

70+
Weight loss
Haematemesis
Dysphagia

25
Prognosis of oesophageal cancer?
<20% 5 year survival
26
Gastric cancer presentation?
``` 50-60 y/o, 'chronic gastritis' Weight loss Anorexia Early satiety Haemorrhage ```
27
Types of gastric cancer?
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
example pathogenesis of intestinal type
H. pylori infection -- chronic gastritis -- reactive hyperplasia -- dysplasia -- adenocarcinoma
29
What are oesophageal varices?
Dilation of collateral veins in lower oesophagus and gastric cardia due to portal hypertension
30
Causes of portal hypertension
PRE - Thrombosis INTRA - cirrhosis, schistosomiasis, sarcoid, myeloproliferative disease POST - Budd Chiari syndrome, right ventricular failure, constrictive pericarditis
31
Score to assess rebreeding or mortality from upper GI bleeding?
Rockall pre and post endoscopy
32
What does pre-endoscopic Rockall score assess?
Age Evidence of shock Comorbidities - CHF, IHD, renal/liver failure, malignancy
33
What additional criteria are on post-endoscopic Rockall score?
Diagnosis | Major stigmata of recent haemorrhage
34
What are the major stimata of recent haemorrhage?
Dark spot - low risk of rebleed | Blood in tract, adherent clot, visible or spurting vessel - high risk of rebleed
35
Non-variceal bleed management
PPI infusion H. Pylori eradication Endoscopic intervention e.g. clips, glue etc
36
Variceal haemorrhage management
Terlipressin - vasopressin analogue to initiate vasoconstriction, platelet aggregation and liver gluconeogenesis
37
H. Pylori eradication?
PPI + clarithromycin + amoxicillin/metronidazole
38
Alternative to pre-endoscopic rockall?
Glasgow blatchford score
39
Terlipressin consequence?
MI
40
Causes of lower GI bleed?
``` Haemorrhoids Diverticulitis IBD Malignancy Polyps Angiodysplasia Infectious diarrhoea ```
41
What is Meckel's diverticulum?
Congenital abnormality due to incomplete obliteration of vitelline duct resulting in ileal diverticulum
42
What is diverticular disease?
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
Where is colonic angiodysplasia most common?
Right colon - risk of bleeding associated with recent anticoagulation
44
What is a Dieulafoy lesion?
Large tortuous artery in submucosa which does not undergo normal branching - commonly in duodenum, colon, jejunum and oesophagus - can bleed
45
Pathogens causing rectal bleeding?
Enterohemorrhagic escherichia Salmonella Histoplasma Cytomegalovirus
46
Less common pathogens for rectal bleeding?
``` Campylobacter Clostridium Shigella Yersinia Cryptosporidium Herpes ```
47
Other cause of lower GI bleed?
Massive upper GI haemorrhage

GI (9 decks)

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