Upper gastrointestinal hemorrhage

Commonest cause of upper GI bleeding is

A. Esophageal erosions
B. Duodenal ulcers
C. Esophageal varices
D. Untreated Gastric ulcers

Not true of assessment of upper GI bleeding is

A. Blatchford score not necessary
B. Full Rockall score after endoscopy
C. Offer endoscopy within 24 hours to all other patients with UGIB
D. Offer endoscopy to unstable patients with severe UGIB immediately

All are true regarding management of non-variceal bleeding except

A. Do not use adrenaline as monotherapy for the endoscopic treatment
B. Thermal coagulation with adrenaline is to be avoided
C. Offer interventional radiology to unstable patients who re-bleed
D. Urgent surgery required if interventional radiology is not available

The first-line treatment for oesophageal varices is

A. Intravariceal injection of cyanoacrylate glue
B. Balloon tamponade
C. Endoscopic band ligation
D. Transjugular intrahepatic portosystemic shunt

Post-endoscopy care in upper GI hemorrhage includes all except

A. PPI intravenous therapy for 14 days
B. H pylori eradication therapy
C. Withholding aspirin until haemostasis is achieved and restarting within 7 days for patients on antiplatelet therapy
D. Terlipressin should be continued for 3–5 days after endoscopic treatment following variceal hemorrhage

Management of stress ulceration includes all except

A. Sucralfate is used as a first-line therapy
B. Infection with C. difficile occurs relatively frequently in mechanically ventilated critically ill patients with stress ulcer prophylaxis
C. Tachyphylaxis can occur with histamine-2 receptor blockers administration
D. Use of PPIs is not associated with the development of tolerance

In short

In a giant ulcer the first part of the duodenum distal gastrectomy with Roux-en-Y reconstruction is better. The duodenal stump may then be closed using the Nissen technique with T-tube drainage.

Mallory–Weiss tear is a longitudinal tear at the gastro-oesophageal junction, it requires under-running to stop bleeding.

Dieulafoy’s disease is a gastric arteriovenous malformation, injection of sclerosant and
endoscopic clips if it is identified at surgery, occasionally, a lesion is only recognised after gastrectomy.

Portal hypertension and portal gastropathy – Octreotide is a somatostatin analogue that reduces portal pressure in patients with varices, and trials suggest that it is of value in arresting hemorrhage.

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