What is the incidence of GI bleed in the UK?
What is the overall mortality of acute GI bleed?
What mainly affects the outcomes of GI bleed?
Identification and promp management
Where can upper GI bleeding occur from?
anywhere proximal to ligament of Trietz
Where can lower GI bleeding occur from?
Bleeding distal to duodenum (jejunum, ileum, colon)
Distal to ligament of Trietz
What is the clinical presentation of upper GI bleed?
Elevated urea (digested blood turns haem into urea)
Dyspepsia, reflux, epigastric pain
What is the clinical presentation of lower GI bleeding?
Normal urea (rarely elevated if proximal small bowel origin)
What can cause upper GI bleeds in the oesophagus?
Mallory Weiss Tear
What can cause upper GI bleeds in the stomach?
Portal hypertensive gastropathy
Are duodenal ulcers or gastric ulcers more common?
Duodenal ulcers (75%)
What are risk factors for peptic ulcers?
Systemic illness (stress ulcers)
How does helicobacter pylori lead to gastric ulcers?
Produces urease -> amonia produced -> buffers gastric acid locally -> increased acid production
How does NSAIDs lead to gastric ulcers?
Prostaglandin production -> reduces mucus and bicarbonate excretion -> reduces physical defences
Why when a gastric ulcer is present is a repeat endoscopy indicated at 8 weeks?
They may have been sitting over a gastric carcinoma
What is Zollinger-Ellison syndrome also known as?
Gastrin-secreting pancreatic tumour
How does Zollinger-Ellison syndrome impact duodenal ulcers?
Causes poor healing of duodenal ulcers
What are the risk factors for gastritis and duodenitis similar to?
Risk factors for gastric and duodenal ulcer
What tends to cause gastritis and duodenitis to bleed?
What are examples of anti-coagulants?
What are examples of anti-platelets?
What are risk factors for oesophagitis?
When is oesophagitis most likely to have significant bleeding?
When on anti-platelets or anti-coagulatns
What are varices secondary to?
Portal hypertension, usually due to liver cirrhosis
What are varices?
Abnormally dilated collateral vessels
What are different types of varices?
Rectal and splenic (rare)
What are examples of upper GI malignancies?
What is a Mallory-Weiss tear?
Linear tear at oesophageal-gastric junction
What does a Mallory-Weiss tear follow a period of?
Vomiting and retching
What is Diuelafoy?
Submucosal arteriolar vessel eroding through mucosa
Where does Diuelafoy commonly occur?