What are the 4 main causes of acute upper GI Bleeding in order?
Mallory-Weiss Tears (caused by forceful vomiting)
Malignancy (rare to come in with bleeding, usually cachexia, metastases or obstruction comes first)
What are the main presentations of upper GI bleeding?
Haematemesis: Bright red blood or brown "coffee groud"
Malaena: Black tarry stools
Bright red blood per rectum: Haematochezia
Iron-deficiency anaemia: but think of oclon cancer first
What is the difference between an erosion and an ulcer?
Erosion: Rarely bleeds. Mucosal lesions with the loss of surface of the epithelium.
Ulcer: Punctured out hole that goes through the muscularis mucosa.
What are the causes? What are its borders like? Where is the most common area off peptic ulcer? What are the most common complications of peptic ulcer?
How do we cure?
H. Pylori, NSAID, Aspirin, Cigarettes, Alcohol, Duodenal gastric reflux, Ischaemia, Shock. These impair defence and lead to gastric acidity and peptic enzymes damaging the surfaces causing an ulcer.
Bening ulcer is a crater. If RAISED borders, it may be a ulcertated cancer.
First part of duodenum is most common. Then stomach antrum, followed by gastroesophageal junction.
Most common is haemorrhage.
Other is perforation leading to sepsis and death.
Also gastric outlet obstruction leading to projectile vomiting, malnourishment and electrolyte imbalance.
Fistula to pancreas cuasing chronic pancreatitis.
Cure: Proton pump inhibitor to stop bleeding. Endoscopy if acutely bleeding with band therapy.
Then combination antibiotic therapy for H. pylori: amoxicillin, tetracycline, metronidazole. Stop NSAIDS.
How can we diagnose H Pylori infection?
Urea Breath Test: Cheap, non-invasive and high-sensitivty and specificity.
Where do we take a biopsy from an ulcer from?
Always take from the margin of an ulcer
What are the causes of oesophageal varices? What else can this cause? How do they kill us? How do we treat?
Secondary to portal hypertension
Pre-hepatic: obstruction of portal vein, spleneomegaly (malaria, leaukaemia, lymphoma)
Intra-hepatic: liver cirrhosis: Alcohol, viral, biliary diseases, haemochromotosis
Post-hepatic: hepatic vein thrombosis
Resistance in liver causes increased pressure going to veins in rectum (haemorrhoids), oesophageal veins and umbilical veins (caput medusae).
Blood in GIT lead to Acute nitrogenous load leads to hepatic enceophalopathy and death.
Endoscopic therapy: Band ligation or scleroteraphy.