upper gi bleeding - aetiology, pathophysiology + clinical features

what are the 3 anatomical categories of causes of upper GI bleeds?

- oesophageal
- gastric
- duodenal

how are upper and lower GI bleeds differentiated?

above ligament of Treitz/suspensory ligament of duodenum = upper GI bleeds
below ligament of Treitz/suspensory ligament of duodenum = lower GI bleeds

what does the suspensory ligament of duodenum/ligament of Treitz also landmark?

duodenojejunal flexure

what are the oesophageal causes of UGIB? (5)

- varices (liver disease)
- oesophagitis
- malignancy
- gastro-oesophageal reflux disease
- mallory-weiss tear

what are the gastric causes of UGIB? (5)

- peptic ulcers
- gastritis
- gastric varices
- mallory-weiss
- malignancy

what are the duodenal causes of UGIB? (4)

- peptic ulcers
- duodenitis
- diverticulum
- aortoduodenal fistula

what is a diverticulum?

outpouching of intestinal mucous membrane

what is an aortoduodenal fistula?

abnormal connection between abdominal aorta and duodenum

how much of UGIB do peptic ulcers account for?

50%

how much of UGIB does gastritis account for?

15-20%

how much of UGIB does oesophageal varices account for?

10-20%

how much of UGIB do Mallory-Weiss tears account for?

5-10%

what is a mallory-weiss tear?

linear mucosal laceration usually at the gastro-oesophageal junction

what are the risk factors for developing an UGIB? (7)

- NSAIDs
- anticoagulants
- alcohol abuse
- chronic liver disease
- chronic kidney disease
- advancing age
- previous peptic ulcers or H. pylori infection

what are the symptoms of UGIB? (10)

- haematemesis
- dizziness
- syncope
- weakness
- abdominal pain
- dyspepsia
- heartburn
- melaena
- haematochezia
- weight loss

what are the signs of UGIB?

- dehydration
- pallor
- confusion
- tachycardia and hypotension
- abdominal tenderness
- melaena
- haematochezia
- stigmata of liver disease (e.g. spider naevi, ascites, hepatomegaly)
- telangiectasia

what is haematochezia?

fresh blood in faeces

what is telangiectasia?

distended capillaries

what is malaena?

tarry stools