Scoring system to predict Rebleeding and Mortality in Peptic Ulcer?
- Blatchford scale - uses clinical parameters only and is calculated from patient’s hemoglobin, blood urea, systolic blood pressure and pulse rate on admission and the presence or absence of melena or syncope as well as of evidence of cardiac or hepatic failure
- Rockall and Baylor Score - Comorbidity, age, shock, diagnosis at time of endoscopy and endoscopic stigmata of recent hemorrhage. (CASDE)Q
The Forrest Classification?
- Grade - Description - Rebleeding Risk
- Ia - Active, pulsatile bleedingQ - High
- Ib - OozingQ, non-pulsatile bleeding - High
- IIa - Non-bleeding visible vesselQ 0 - High
- IIb - Adherent clotQ - Intermediate
- IIc - Black dotQ -- Low
- III - Clean baseQ – Low
Causes of Upper Gastrointestinal Hemorrhage?
- Non-variceal Bleeding (80%)Q
- Portal Hypertensive Bleeding (20%)Q
Rate of bleeding at which angiography can detect?
an detect hemorrhage in the range of 0.5 to 1.0 mL/minQ
Rate of bleeding which tagged RBC can detect?
Role of beta-blockers in UGI bleeding?
- Beta-blockers are used in secondary prevention of recurrent variceal bleed.
- Beta-blockers have no role in the management of acute upper GI bleeding.
Treatment of choice for variceal bleedingQ?
What is Mallory Weiss Syndrome?
- Forceful contraction of the abdominal wall against an unrelaxed cardia, resulting in mucosal laceration of the proximal cardiaQ as a result of the increase in intragastric pressure.
- Results in disruption of gastric mucosa high on the lesser curve at cardia (just below GE junction)Q
- Tear is partial thickness, extending through the mucosa and submucosaQ
- Arterial bleeding, usually painless and are rarelyQ associated with massive bleeding
Treatment of Mallory Weiss Syndrome?
- Supportive therapy
- Mucosa often heals within 72 hoursQ
Role of Sengstaken Blakemore tube and Mallory Weiss syndrome?
Sengstaken-Blakemore tube will not stop bleeding in Mallory-Weiss syndrome, as the bleeding is arterial and the pressure in the balloon is not sufficient to overcome the arterial pressure and is contraindicatedQ.
What is Dieulafoy’s Lesion?
- These are caused by an abnormally large (1–3 mm)Q, tortuous artery coursing through the submucosa
- Occurs 6–10 cm from the GE junction, generally in the ‘fundus’ near the cardia along the lesser curvatureQ.
Treatment of Dieulafoy’s lesion?
- • Initial attempts at endoscopic control are often successfulQ,
- • Application of thermal or sclerosant therapy is effective in 80–100% of cases.Q
- • In cases that fail endoscopic therapy, angiographic coil embolization can be successfulQ.
- • Gastric wedge resection to include the offending vessel is reserved when other modalities have failed
What is Watermelon Stomach?
- Gastric Antral Vascular Ectasia
- It is a rare entity characterized by presence of both inflammatory and vascular components in mucosaQ.
- On endoscopy: Prominent longitudinal folds with parallel striking red stripes atop the mucosal folds of the distal stomach, much like the rind of a watermelon
What is Ménétrier’s disease?
- Hypoproteinemic Hypertrophic Gastropathy – associated with hypochlorhydria or achlorhydriaQ
- Characterized by massive gastric folds in the fundusQ and corpus of the stomach, giving the mucosa a cobblestone or cerebriform appearanceQ.
- Associated with CMV infection in childrenQ and H. pylori infection in adultsQ
Treatment of Menetrier’s disease?
- • Medical treatment is limited to albumin replacement and maintenance of adequate nutrition, acid suppression, octreotide and H. pylori eradicationQ.
- • Total gastrectomy for bleeding, severe hypoproteinemia or cancerQ.
Most common gastric polyp?
HyperplasticQ or regenerative polyp