Endoscopic Procedures: Diagnosis and Management

Study Notes

Endoscopic Procedures

Diagnostic endoscopy identifies causes of gastrointestinal bleeding, such as duodenal ulcers, which can lead to significant hemorrhage by affecting the gastroduodenal artery.
Hemostatic measures play a crucial role in managing and controlling bleeding during endoscopic procedures.
Forrest classification assists in determining the risk of rebleeding, with categories including spurter, visible vessel, adherent clot, and various degrees of ulcer base appearance totaling five classifications.

Forrest Classification Breakdown

Ia: Arterial spurting
Ib: Oozing from ulcer base
IIa: Visible vessel
IIb: Adherent clot
IIc: Black spots
III: Clean ulcer base

Endoscopic Risk Signs

A visible vessel indicates a 50% risk of rebleeding.
Spurting blood and overlying adherent clots are also critical indicators.
Red or black spots at the ulcer base correspond to a 10% risk of rebleeding.

Heat Probe and Laser Photocoagulation

Heat probe features an aluminum tip with a heating coil for coagulation during bleeding control.
Laser photocoagulation employs energy for effective hemostasis, utilizing techniques like Argon and YAG lasers.

Upper Gastrointestinal Tract (UGIT) Bleeding

UGIT bleeding refers to hemorrhage occurring proximal to the ligament of Treitz.

Common Causes of UGIT Bleeding

Esophageal: Reflux esophagitis, varices, Mallory Weiss tear, carcinoma.
Gastric: Erosive gastritis, varices, portal hypertension gastropathy, PUD, gastric tumors.
Duodenal: Conditions like duodenitis and duodenal PUD, with duodenal carcinoma being notable.
In Egypt, the most prevalent causes of UGIT bleeding include esophageal varices, erosive gastritis, and both gastric/duodenal ulcers.

Clinical Presentation of GIT Bleeding

Hematemesis: Vomiting blood, categorized by severity from mild to massive.
Hematochezia: Fresh rectal bleeding, indicative of massive bleeding.
Melena: Characterized by black, tarry stools; may note a gray appearance if iron is present.

Management of Peptic Ulcer Bleeding

Most PUD bleeds (80%) stop spontaneously without intervention.
Diagnosis includes evaluating epigastric tenderness and performing endoscopy, especially for posterior ulcer sites.
Clinical severity ranges from mild coffee-ground hematemesis to severe fresh blood vomiting accompanied by signs of shock.

Management Steps

Maintain NPO status until endoscopy.
Perform NGT lavage and establish IV lines for fluid and blood transfusions.
Vital signs and urinary output must be closely monitored.
Consider pharmaceutical interventions including H2 blockers, PPIs, and coagulants like vitamin K for coagulopathy.

Surgical Intervention in GIT Bleeding

Indications for surgical referral include continuous bleeding after endoscopic procedures and bleeding gastric varices.
Pharmacological treatment with propranolol decreases portal blood pressure to prevent recurrence.

Mallory Weiss Tear

Characterized by a linear tear at the gastroesophageal junction often due to excessive vomit pressure.

Dieulafoy’s Lesion

Involves an abnormally large tortuous artery in the submucosa, typically near the gastroesophageal junction, necessitating endoscopic or surgical treatment.

Sclerotherapy and Band Ligation

Sclerotherapy is effective in 80-90% of cases for controlling variceal bleeding through injecting sclerosant material.
Endoscopic band ligation proves effective with fewer complications compared to sclerotherapy.

Complications and Treatment of Erosive Gastritis

The main cause is NSAID use; conservative management is advised until transfusion necessity is significant.

Summary of Treatments

Various interventions include medical treatments, endoscopic measures, and surgical techniques aimed at controlling GIT bleeding effectively and minimizing complications.

Description

This quiz focuses on endoscopic procedures related to diagnosing and managing gastrointestinal bleeding. It covers critical topics such as the diagnosis of duodenal ulcers, hemostatic measures, and the evaluation of rebleeding risks using the Forrest classification. Test your knowledge in these essential medical procedures and classifications.