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Finals: Surgery > Upper GI Bleed > Flashcards

Upper GI Bleed Flashcards

1
Q

Upper GI bleeding is bleeding for a source proximal to which structure?

A

Ligament of Treitz

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2
Q

Define the ligament of Treitz

A

Ligament of Treitz is a band of peritoneum that is located at the junction between the duodenum and the jejunum

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3
Q

Is upper GI bleed more common in males or females

A

Males

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4
Q

Name the 7 risk factors for upper GI bleed

A
  • Medications

NSAIDs

Anticoagulants

  • Alcohol abuse
  • Chronic liver disease
  • Chronic kidney disease
  • Advancing age
  • H. pylori infection
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5
Q

What does NSAIDs inhibit the synthesis of?

A

Prostaglandins

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6
Q

Describe the pathogenesis of how NSAID use can cause an upper GI bleed

A
  • NSAIDs inhibit the synthesis of prostaglandins, which are gastroprotective.
  • Prostaglandins work by inhibiting enterochromaffin-like cells, which are involved in the secretion of histamine.
  • Histamine stimulates parietal cells to secrete hydrochloric acid.
  • Thus, inhibition of prostaglandins leads to excessive HCl secretion and damage to the underlying mucosa.
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7
Q

Name the 3 most common cause of upper GI bleed

A

Peptic ulcer disease

Gastritis

Oesophageal varices

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8
Q

Name some of the causes of an upper GI bleed from the oesphagus

A
  • Oesophagitis i.e. inflammation of the oesophagus
  • Oesophageal varices
  • Malignancy
  • Gastro-oesophageal reflux disease (GORD)
  • Mallory-Weiss tear i.e. tear of the oesophageal mucous membrane
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9
Q

Name some of the causes of an upper GI bleed from the stomach

A
  • Peptic ulcer disease
  • Mallory-Weiss tear
  • Gastric varices
  • Gastritis i.e. inflammation of the stomach
  • Malignancy
  • Gastric ulceration
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10
Q

Name some of the causes of an upper GI bleed from the duodenum

A
  • Peptic ulcer disease
  • Diverticulum
  • Aortoduodenal fistula
  • Duodenitis i.e. inflammation of the duodenum
  • Duodenal ulceration
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11
Q

Define Oesophagitis

A

Refers to inflammation of the intraluminal epithelial layer of the oesophagus

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12
Q

Oesophagitis affects which layer of the oesphageal wall

A

The intraluminal epithelial layer

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13
Q

Name the 6 causes of the Oesophagitis

A

Gastroesophageal reflux disease (GORD) -Most common

less common causes include:

Infections e.g. Candida Albicans

Medications e.g. bisphosphonates

Radiotherapy

Ingestions of toxic substances

Crohn’s disease

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14
Q

What is the definition of Oesophageal Varices

A

Refers to dilations of the porto-systemic venous anastomoses in the oesophagus

These dilated veins are swollen, thin-walled and hence prone to rupture

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15
Q

What is the most common underlying cause for oesophageal varices

A

Portal hypertension resulting from chronic liver disease/cirrhosis

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16
Q

Describe the pathogenesis of how portal hypertension can leads to oesophageal Varices

A

Increases in portal pressure leads to the development of a collateral circulation to overcome the obstruction to flow in the portal system

The lower end of the oesophagus forms an important ‘portacaval anastomosis’ which allows the flow of venous blood from the portal system to the systemic circulation

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17
Q

Define the term Mallory-Weiss Tear

A

It is a result of a forceful vomiting causing a tear in the epithelial lining of the oesophagus, resulting in a small bleed

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18
Q

What is the classic presentation of Mallory-Weiss Tear

A

Episodes of severe or recurrent vomiting, then followed by minor haematemesis

19
Q

What is the management option for Mallory-Weiss Tear

A

Most cases are benign and will resolve spontaneously

20
Q

If the patient with Mallory-Weiss Tear has a prolonged or worsening haematemesis. What should they be investigated with?

A

Oesophago-gastro-duodenoscopy (OGD)

21
Q

Define the term “haematemesis”

A

Vomiting blood

22
Q

Where does mallory-weiss occur

A

Tear of the tissue of your lower esophagus

23
Q

Peptic ulcer disease can cause the development of which type of ulcers

A

Gastric and duodenal ulcers

24
Q

How does a gastric or duodenal ulcer secondary to peptic ulcer disease cause an upper GI bleed

A

Occurs due to the erosion of the ulcer through into the blood vessels supplying the upper GI tract causing the bleeding

25
Q

Peptic ulcer disease is strongly associated with which infection?

A

Helicobacter pylori infection

26
Q

What are the two types of haematemesis

A

The vomiting of fresh blood

The vomiting of “coffee ground vomit” - where the blood is partially digested

27
Q

What makes coffee ground vomit “coffee ground”?

A

It is coffee ground because the blood is partially digested

28
Q

Define the term melanea

A

Passing of black tarry faeces discoloured by the presence of digested blood

29
Q

Why is melaena black in colour?

A

The faeces are discoloured by the presence of digested blood

30
Q

What are the key features of upper GI bleed

A

Haematemesis i.e. vomiting blood

AND/OR

Melaena

AND/OR

Features of shock e.g., hypotension, collapse

31
Q

What two scoring stratification tools are used to identify high-risk patients and those that need prompt intervention in upper GI bleed

A

Glasgow-Blatchford score – primary assessment tool

Rockall score – useful after endoscopy

32
Q

What scoring system is used as the primary assessment tool for patients presenting with upper GI bleeding:

A

Glasgow-Blatchford score

33
Q

When should the Rockall scoring system be used in upper GI bleed

A

Post-endoscopy

34
Q

Why does urea rise in upper GI bleeds?

A

The blood in the GI tract gets broken down by acid and digestive enzymes

One of the breakdown products is urea and this urea is then absorbed in the intestines.

35
Q

Name the crtieria of the Blatchford score

A
  • Drop in Hb
  • Rise in urea
  • Blood pressure
  • Heart rate
  • Melaena
  • Syncope i.e. loss of consciousness
36
Q

Name the criteria for the Rockall score

A

Mnemonic ABCDE

A- Age

B - BP and HR

C - Co-morbidities

D - Diagnosis

E - Endoscopic findings

37
Q

What is the gold standard investigation for upper GI bleed

A

Upper GI endoscopy i.e. oesophago-gastro-duodenoscopy (OGD)

38
Q

What is the management for upper GI bleeds

A

Mnemonic “ABATED”

A – ABCDE approach to immediate resuscitation

B – Bloods

A – Access (ideally 2 large bore cannula)

T – Transfuse

E – Endoscopy (arrange urgent endoscopy within 24 hours)

D – Drugs (stop anticoagulants and NSAIDs)

39
Q

What is the most common cause of non-variceal upper GI bleed

A

Peptic ulcer disease

40
Q

Name the endoscopic management options for non-variceal upper GI bleeds

A

Dual therapy at the time of endoscopy either:

Adrenaline AND Mechanical (clips)

OR

Adrenaline AND Therapy Coagulation

41
Q

Name the endoscopic management options for variceal upper GI bleeds

A

Variceal band ligation (VBL)

42
Q

Name the pharmacological management options for non-variceal upper GI bleeds

A

PPI

43
Q

Name the pharmacological management options for variceal upper GI bleeds

A

Terlipressin (IV injection): to reduce portal pressures

Prophylactic antibiotic therapy: to reduce the risk of spontaneous bacterial peritonitis

44
Q

Describe the mechanism of action of Terlipressin?

A

Terlipressin is an analogue of vasopressin (ADH)

It causes splanchnic vasoconstriction, which in turn reduces portal pressures

Finals: Surgery (10 decks)

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