Saturday, September 8, 2012

Upper GI Bleed

Q What is the most common cause of upper GI Bleed in Cirrhotics

a) Portal Hypertension

b) Portal hypertensive gastropathy

c) Peptic ulcer disease

d) Mallory Weiss Syndrome


Answer

c- Peptic ulcer disease

Although patients with cirrhosis are at high risk of developing variceal bleeding, nonvariceal sources account for most upper GI bleeds, even in these patients. It is beacuse of the mortality of variceal bleeding associated with cirrhosis that in all patients with cirrhosis with UGIE early medical treatment is instituted.

In Cirrhosis more than 50% of upper GI bleed is caused by Non variceal cause.

Gastroesophageal varices develop in approximately 30% of patients with cirrhosis and portal hypertension and 30% in this group develop variceal bleeding. Compared with nonvariceal bleeding, variceal hemorrhage is associated with an increased risk of rebleeding, increased need for transfusions, longer hospital stay, and increased mortality.

References- 1. Sabiston textbook of surgery 19th edition

2. Rockey DC: Gastrointestinal bleeding. Gastroenterol Clin North Am 2005; 34:581-588.