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Lernmaterialien für GASTRO - VOMITTING BLOOD PBLS an der University of Birmingham

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TESTE DEIN WISSEN

What signs and symptoms would a patient present with if they had PUD?

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TESTE DEIN WISSEN

Nausea or Vomitting

Coffee-ground  vomitting 

Malaena if bleeding

Reduced appetite

Anaemia e.g. Fatigue

'Burning' epigastric pain


Lösung ausblenden
TESTE DEIN WISSEN

How would we investigate a patient with GORD?

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TESTE DEIN WISSEN
  • Testing for Helicobacter pylori: see here. This is to ensure the symptoms are not due to H.pylori. Note, H.pylori is not associated with GORD


  • Endoscopy: most patients with GORD have normal endoscopy. There may be evidence of oesophagitis or Barrett’s oesophagus. The role of endoscopy is to rule out any complications or alternative diagnoses


  • 24 hour pH study: if the endoscopy is normal and there is a strong suspicion for GORD, a catheter can be used to monitor pH at the GOJ for 24 hours


  • Oesophagal manometry: measures the functionality of the lower oesophageal sphincter and is useful for assessing for oesophageal dysmotility
Lösung ausblenden
TESTE DEIN WISSEN

Describe the pain a pt with PUD expierences?

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TESTE DEIN WISSEN

Burning epigastric pain


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TESTE DEIN WISSEN
What is the scoring system for Mallory Weiss Tear?
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TESTE DEIN WISSEN
Glasgow Blatchford Score 

Those with a score of 0 can be discharged and return for an outpatient endoscopy. If the score is more than 0, patients require admission for inpatient endoscopy. 

Factors Taken into accounf

Haemoglobin
Urea
Initial systolic blood pressure 
Gender
Heart rate (tachycardia)
Melaena
History of syncope
Hepatic disease history 
Cardiac failure present
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TESTE DEIN WISSEN

Are there any complications from having GORD?

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TESTE DEIN WISSEN
  • Barrett’s oesophagus [8]
  • Oesophageal ulceration/oesophagitis
  • Oesophageal stricture: fibrosis/scarring leads to narrowing of the oesophageal lumen
  • Anaemia: due to chronic blood loss (usually with severe oesophagitis)
  • Aspiration pneumonia
  • Dental problems: such as erosions, gingivitis, and halitosis
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TESTE DEIN WISSEN

What are the Clinical features of GORD

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TESTE DEIN WISSEN
  • Heartburn [worse by lying down]
  • Sour/bitter taste of acid 
  • Difficulty in swallowing 
  • Nausea
  • Hoarseness & Chronic cough
Lösung ausblenden
TESTE DEIN WISSEN
what are the signs and symptoms of Mallory Weiss Tear
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TESTE DEIN WISSEN
Preceding retching and vomiting 
Melaena on rectal examination: an uncommon feature
Vomiting blood: usually a small to moderate volume of bright red blood, which is self-limiting
Features of shock: an uncommon feature
Melaena: rare

Epigastric pain: in some patients
Lösung ausblenden
TESTE DEIN WISSEN
What is Mallory Weiss Tear
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TESTE DEIN WISSEN
Mallory-Weiss tear (MWT) refers to longitudinal lacerations limited to the mucosa and submucosa, at the border of the gastro-oesophageal junction.


MWT is caused by a sudden rise in intra-abdominal and transmural pressure across the gastro-oesophageal junction secondary to vomiting and retching in the presence of a preexisting damaged gastric mucous membrane, which is often related to alcoholism. This causes a subsequent laceration resulting in an upper GI bleed that is usually self-limiting.
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TESTE DEIN WISSEN

What is peptic ulcer disease

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Definition: break in the mucosal lining of the stomach, duodenum, or lower oesophagus more than 5mm diameter with depths to the submucosa. 

                                                           

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TESTE DEIN WISSEN

What is H. pylori?

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TESTE DEIN WISSEN

Helicobacter pylori (H. pylori) is a type of bacteria. These germs can enter your body and live in your digestive tract. After many years, they can cause sores, called ulcers, in the lining of your stomach or the upper part of your small intestine. For some people, an infection can lead to stomach cancer.

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TESTE DEIN WISSEN
How is MWT managed?
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TESTE DEIN WISSEN
First Line
  • Upper GI endoscopy: diagnostic and therapeutic with one of the following suggested
  • Clipping +/- adrenaline
  • Thermal coagulation with adrenaline 
  • Sclerotherapy with adrenaline 
  • High-dose IV proton pump inhibitor: administered post-endoscopy to reduce rebleeding; e.g. pantoprazole. Should not be given before endoscopy as may mask bleeding
  • Manage contributing factors: for example, offer a long-term proton pump inhibitor if there is evidence of GORD
Lösung ausblenden
TESTE DEIN WISSEN

What is Barrett’s Oesophagus? Does it have any significance?

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TESTE DEIN WISSEN

Barrett’s oesophagus describes metaplasia (transformation of one differentiated cell type to another differentiated cell type) of the lower oesophageal lining from stratified squamous epithelium to mucous secreting columnar epithelium with goblet cells. It occurs in response to acidic stress and is therefore associated with gastro-oesophageal reflux disease (GORD).

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Q:

What signs and symptoms would a patient present with if they had PUD?

A:

Nausea or Vomitting

Coffee-ground  vomitting 

Malaena if bleeding

Reduced appetite

Anaemia e.g. Fatigue

'Burning' epigastric pain


Q:

How would we investigate a patient with GORD?

A:
  • Testing for Helicobacter pylori: see here. This is to ensure the symptoms are not due to H.pylori. Note, H.pylori is not associated with GORD


  • Endoscopy: most patients with GORD have normal endoscopy. There may be evidence of oesophagitis or Barrett’s oesophagus. The role of endoscopy is to rule out any complications or alternative diagnoses


  • 24 hour pH study: if the endoscopy is normal and there is a strong suspicion for GORD, a catheter can be used to monitor pH at the GOJ for 24 hours


  • Oesophagal manometry: measures the functionality of the lower oesophageal sphincter and is useful for assessing for oesophageal dysmotility
Q:

Describe the pain a pt with PUD expierences?

A:

Burning epigastric pain


Q:
What is the scoring system for Mallory Weiss Tear?
A:
Glasgow Blatchford Score 

Those with a score of 0 can be discharged and return for an outpatient endoscopy. If the score is more than 0, patients require admission for inpatient endoscopy. 

Factors Taken into accounf

Haemoglobin
Urea
Initial systolic blood pressure 
Gender
Heart rate (tachycardia)
Melaena
History of syncope
Hepatic disease history 
Cardiac failure present
Q:

Are there any complications from having GORD?

A:
  • Barrett’s oesophagus [8]
  • Oesophageal ulceration/oesophagitis
  • Oesophageal stricture: fibrosis/scarring leads to narrowing of the oesophageal lumen
  • Anaemia: due to chronic blood loss (usually with severe oesophagitis)
  • Aspiration pneumonia
  • Dental problems: such as erosions, gingivitis, and halitosis
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Q:

What are the Clinical features of GORD

A:
  • Heartburn [worse by lying down]
  • Sour/bitter taste of acid 
  • Difficulty in swallowing 
  • Nausea
  • Hoarseness & Chronic cough
Q:
what are the signs and symptoms of Mallory Weiss Tear
A:
Preceding retching and vomiting 
Melaena on rectal examination: an uncommon feature
Vomiting blood: usually a small to moderate volume of bright red blood, which is self-limiting
Features of shock: an uncommon feature
Melaena: rare

Epigastric pain: in some patients
Q:
What is Mallory Weiss Tear
A:
Mallory-Weiss tear (MWT) refers to longitudinal lacerations limited to the mucosa and submucosa, at the border of the gastro-oesophageal junction.


MWT is caused by a sudden rise in intra-abdominal and transmural pressure across the gastro-oesophageal junction secondary to vomiting and retching in the presence of a preexisting damaged gastric mucous membrane, which is often related to alcoholism. This causes a subsequent laceration resulting in an upper GI bleed that is usually self-limiting.
Q:

What is peptic ulcer disease

A:

Definition: break in the mucosal lining of the stomach, duodenum, or lower oesophagus more than 5mm diameter with depths to the submucosa. 

                                                           

Q:

What is H. pylori?

A:

Helicobacter pylori (H. pylori) is a type of bacteria. These germs can enter your body and live in your digestive tract. After many years, they can cause sores, called ulcers, in the lining of your stomach or the upper part of your small intestine. For some people, an infection can lead to stomach cancer.

Q:
How is MWT managed?
A:
First Line
  • Upper GI endoscopy: diagnostic and therapeutic with one of the following suggested
  • Clipping +/- adrenaline
  • Thermal coagulation with adrenaline 
  • Sclerotherapy with adrenaline 
  • High-dose IV proton pump inhibitor: administered post-endoscopy to reduce rebleeding; e.g. pantoprazole. Should not be given before endoscopy as may mask bleeding
  • Manage contributing factors: for example, offer a long-term proton pump inhibitor if there is evidence of GORD
Q:

What is Barrett’s Oesophagus? Does it have any significance?

A:

Barrett’s oesophagus describes metaplasia (transformation of one differentiated cell type to another differentiated cell type) of the lower oesophageal lining from stratified squamous epithelium to mucous secreting columnar epithelium with goblet cells. It occurs in response to acidic stress and is therefore associated with gastro-oesophageal reflux disease (GORD).

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