UGI bleeding

Question 1

Name the 3 main causes of UGI bleeding

Answer 1

Varices
Peptic ulcer disease
Gastric erosions (NSAIDs)

Question 2

Name additional causes of UGI bleeding

Answer 2

Mallory-Weiss tears
Malignant ulcer
GIST
Uremic gastritis
Dieulafoy's disease
Curling ulcer 
Cushing ulcer 
Aorto-enteric fistula 
Haemosuccus pancreaticus 
Telangiectasia AVM

Question 3

Name causes of haemobilia

Answer 3

1. Iatrogenic
   - ERCP
   - sphincterotomy
   - EUS pancreas biopsy
   - hepato-biliary surgery
   - percutaneous liver biopsy
   - PTC
2. Trauma
3. Neoplasms
4. Inflammation
5. Infection
6. Gallstones
7. Haemosuccus pancreaticus
8. Severe coagulopathy

Question 4

What are isolated duodenal varices associated with?

Answer 4

SMV thrombosis

Question 5

Discuss treatment options for bleeding duodenal varices

Answer 5

Octreotide
Endoscopic 
- banding
- clips
- sclerotherapy 
TIPS 
Suture ligation
Local resection

Question 6

Discuss the classification system of duodenal varices

Answer 6

Non-occlusive = a
Occlusive = b
Portal collaterals = 1 
Predominantly portoportal = 2
Predominantly portosystemic = 3

Question 7

What is a Dieulafoy’s lesion

Answer 7

A large tortuous arteriole in gastric submucosa that erodes and bleeds