Git Bleeding

Question 1

Risk factors

Answer 1

A- Medical Conditions

1_Peptic ulcer disease (most common cause)

2-Esophageal varices (due to portal hypertension)

3-Gastritis or duodenitis

4-Gastroesophageal reflux disease (GERD)

5-Mallory-Weiss tears (mucosal laceration due to severe vomiting)

6-Gastric or esophageal cancer

7-Dieulafoy lesion (abnormal artery in the stomach)

8-Angiodysplasia

Question 2

Risk factors

Answer 2

B- Medications

1-NSAIDs (e.g., ibuprofen, aspirin) – damage the gastric mucosa

2-Anticoagulants (e.g., warfarin, DOACs) – increase bleeding risk

3-Corticosteroids – especially when combined with NSAIDs

4-SSRIs – associated with increased bleeding risk

Question 3

Risk factors

Answer 3

B-Lifestyle Factors

1-Alcohol use – causes gastritis and varices

2-Smoking – impairs mucosal healing

3-Chronic vomiting – can lead to Mallory-Weiss tears
4-stress
4-Diet

Question 4

Risk factors

Answer 4

D-Infections

Helicobacter pylori infection – strongly associated with peptic ulcers

Question 5

Risk factors

Answer 5

E- Systemic Factors

1-Liver disease – leads to varices and coagulopathy
Coagulopathies – congenital or acquired
2-Renal failure – associated with uremic gastritis

Question 6

Management

Answer 6

2. Endoscopic Management

Performed after initial stabilization (typically within 24 hours):

Diagnostic Endoscopy

Identifies source of bleeding (Forrest classification can help guide therapy).

Therapeutic Endoscopy

Indicated for active bleeding or high-risk stigmata (Forrest Ia–IIb):

Injection therapy (e.g., epinephrine)

Thermal coagulation (e.g., heater probe, bipolar coagulation)

Mechanical therapy (e.g., hemoclips)

Often combination therapy (e.g., epinephrine + clips) is most effective.

Question 7

Management

Answer 7

Medical Management

1-Initial Stabilization

Airway, Breathing, Circulation (ABC) – resuscitate as needed.

IV fluids – isotonic saline or Ringer’s lactate.

Blood transfusion – if hemoglobin <7 g/dL (or <9 g/dL in high-risk patients).

Correct coagulopathies – vitamin K, fresh frozen plasma, platelets if indicated.

Pharmacologic Therapy

Proton Pump Inhibitors (PPIs):

High-dose IV (e.g., omeprazole 80 mg bolus, then 8 mg/hr infusion for 72 hrs).

Reduces rebleeding risk by stabilizing clot in low-acid environment.

Eradicate H. pylori (if present) – with triple or quadruple therapy.

Discontinue NSAIDs and anticoagulants if possible.