THEME III: ACUTE GASTRO-INTESTINAL BLEEDINGS. PEPTIC ULCER – COMPLICATIONS
1. What is the definition of haematemesis?
- Haemathemesis → Blood vomiting
- The patients vomiting dark-brown materials (similar to coffee grounds).
- The dark-brown colour of the vomiting content is due to reduction of haemoglobin into hematin, this process is caused by hydrochloric acid.
2. What is the is definition of melaena?
- Melena → Defecation of tarry black stool.
- Gastrointestinal bleeding is presented like melena when at least 50ml of blood has been in intestine for more than 8 hours
- Source of bleeding is proximal then flexura coli hepatica. Hepatic flexture !!
- The black colour of stools in cases of melaena is due to iron sulphite, which is produced by the process of bacterial disintegration of haemoglobin.
3. What is the definition of haematochesia?
- Haematochesia → Defecation of blood (Synonym is rectorrhagia)
- Haematochesia is typical for intestinal bleeding.
- Source of bleeding more distally than flexura coli hepatica.
4. What is the definition of acute upper gastrointestinal bleedings?
- This is gastro-intestinal bleeding with source of haemorrhage proximally from ligamentum Treitz (duodenum-jejunum connection – from esophagus, stomach, and duodenum). Suspensary M. of Duodenum, connects Junction btw duodenum + jejunum to Right Crus of Diaphragm
5. In which two diseases haematochesia may be presented as a massive haemorrhage?
- Ulcerous colitis
- Large intestine diverticulosis
- These are the two diseases that may be clinically presented with as a massive haemorrhage – fresh blood in the stool (bloody diarrhoea).
6. What is typical bleeding in cases of haemorrhoids?
- Rectal bleeding (fresh blood, not mixed with stool) during the defecation or immediately after defecation.
7. What does Mallory-Weiss syndrome mean?
Mallory-Weiss syndrome denotes
- → linear tearing of esophageal mucosa, caused by repeatedly vomiting.
longitudinal mucosal tear @ gastro esophageal junction in lower oesophagus/Proximal to Stomach due to sudden forceful vomiting or retching
ie. Alcohol binge, eating disorders.
8. Which is the most common cause of upper gastro-intestinal bleeding?
- The peptic ulcers are the cause of more than 2/3 of gastro-intestinal bleeding.
9. Which is the main method of diagnosis of gastro-intestinal bleeding?
- Emergency upper endoscopy (esophago-gastro-duodenoscopy)
- → Is the main instrumental method of the diagnosis of gastrointestinal bleeding.
10. Which classification is used to determine the endoscopic severity of stomach and duodenal ulcer bleeding?
classify ulcers based of endoscopic appearance, Predict risk of bleeding
- Forest classification is used to determine the endoscopic severity of stomach and duodenal ulcer bleeding.
11. Which are peptic ulcer complication?
- Bleeding