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GIHEP > L23: GI Bleed - PUD > Flashcards

L23: GI Bleed - PUD Flashcards

1
Q

List 3 common causes of peptic ulcer disease

A
  • H. pylori
  • NSAID use
  • gastrinoma (ZE)
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2
Q

List some of the symptoms of peptic ulcer disease

A
  • epigastric pain (dull, gnawing pain)
  • waterbrash = acid reflux into mouth
  • heartburn = acid reflux into oesophagus
  • anaemia
  • weight loss
  • early satiety
  • malaena/haematemesis
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3
Q

What are some complications of peptic ulcer disease?

A
  • gastric outlet obstruction
  • penetration + fistulation
  • perforation (+ peritonitis)
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4
Q

What is malaena?

A
  • black, tarry, foul-smelling stool

- containing blood from upper GIT

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5
Q

What is haematemesis?

A

bright, fresh blood being vomited out

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6
Q

If blood from haematemesis is bright red, where is it probably coming from?

A

oesophagus

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7
Q

If a patient has “coffee ground vomit”, where is the blood probably coming from?

A

stomach

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8
Q

What is the Blatchford Score?

A

helps identify which patients with upper GI bleeding may be safely discharged from the emergency room

  • can be used for PUD which causes bleeding
  • determines severity of bleed
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9
Q

Why is an erect chest x-ray done when investigating peptic ulcer disease?

A

free air under diaphragm present when there is a perforated peptic ulcer

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10
Q

What 2 tests can be done to check if H. pylori is present in peptic ulcer disease?

A
  1. CLO Test

2. Urease Breath Test

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11
Q

List 3 things that can give a false positive in the detection of H. pylori through a CLO test?

A
  1. Long-Term PPI Use
  2. Antibiotic Use
  3. Recent GI Bleed
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12
Q

H. pylori peptic ulcer disease increases the risk of which 2 cancers?

A
  1. Gastric Adenocarcinoma

2. Gastric MALToma

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13
Q

What is the main treatment for symptomatic NON-BLEEDING peptic ulcers?

A

Proton Pump Inhibitors

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14
Q

PPIs are the first-line treatment for symptomatic NON-BLEEDING peptic ulcers. If PPIs are contraindicated, what may be given?

A

H2 Antagonists

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15
Q

What are the side effects of PPIs?

A 
hyponatraemia
risk of C. difficile infection
hypomagnesemia
risk of osteoporotic fractures
pneumonia
vitamin B12 deficiency
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16
Q

What is Triple Therapy Eradication used for?

A

H. pylori peptic ulcer disease

17
Q

What is Triple Therapy Eradication treatment?

A
  • used for H. pylori peptic ulcer disease
  • 1 PPI
  • 2 Antibiotics
  • used for 14 days
18
Q

What is an OGD? What is it used for?

A

oesophago-gastro-duodenoscopy

- used to investigate PUD and GI bleeding

19
Q

What is a highly selective vagotomy? What is it used for?

A
  • last resort treatment for PUD

- inhibits vagus nerve to stop stomach from producing too much acid

20
Q

What is the clinical + laboratory features of Zollinger-Ellison syndrome?

A
  • duodenal ulcers (no H. pylori + failure to heal w/ PPI or H2 antagonists)
  • diarrhea
  • hypergastraemia
  • hypercalcaemia
  • endocrinopathy
21
Q

Which ligament splits upper GI and lower GI bleeding?

A

Ligament of Treitz

22
Q

What is haematochezia?

A
  • indicates a lower GI bleed

- bright fresh blood from rectum

23
Q

What are the 2 main types of upper GI bleeding?

A
  1. Non-Variceal

2. Variceal

24
Q

What is haemoptysis?

A

vomited or coughed up blood

25
Q

What is epistaxis?

A

blood coming from the nose or nasopharynx

26
Q

If there is an upper GI bleeding, weight loss and dysphagia what is the most likely diagnosis?

A

carcinoma

27
Q

If there is upper GI bleeding after forceful vomiting what is the most likely diagnosis?

A

Mallory-Weiss tear

28
Q

If there is upper GI bleeding in someone who drinks a lot of alcohol what is the most likely diagnosis?

A

variceal-related upper GI bleed

29
Q

What does pallor of the conjunctiva suggest?

A

anaemia

30
Q

What does pallor of the palmar creases suggest?

A

anaemia

31
Q

If a patient experiences epigastric pain that is worsened by food, what type of peptic ulcer do they have?

A

gastric ulcer

32
Q

If a patient experiences epigastric pain that is worsened when hungry, what type of peptic ulcer do they have?

A

duodenal ulcer

33
Q

Most of upper GI bleeds are due to a peptic ulcer. In this regard, is a duodenal or gastric ulcer more likely to bleed?

A

duodenal ulcer

34
Q

What is the Rockall Score used for? What do the scores mean?

A
  • to determine the severity of GI bleeding
  • done after endoscopy is completed

< 3 = good prognosis
> 8 = high mortality

35
Q

What is the treatment for an EMERGENCY variceal upper GI bleed?

A

Terlipression

  • also blood transfusion if Hb < 8g/dL
  • do an endoscopy with variceal banding
36
Q

What is the treatment for an EMERGENCY NON-variceal upper GI bleed?

A

IV PPI

  • also blood transfusion if Hb < 8g/dL
  • do an OGD to find source of bleeding
37
Q

How does Terlipression work and what is it used for?

A
  • used for VARICEAL upper GI bleed

- narrows blood vessels to stop bleeding

GIHEP (24 decks)

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