BASIC KNOWLEDGE

GASTROINTESTINAL BLEEDING
EPIDEMIOLOGY
• The incidence of bleeding from the upper GIT tract is approximately
100 cases per 100,000 population.
• The most common cause of upper GI hemorrhage is peptic ulceration
of the stomach or duodenum, with or without aspirin or NSAID. 50%
duodenal ulcers are silent.
• The next most common cause is variceal bleeding, then Mallory-Weiss
syndrome with laceration from excessive vomiting with trauma, and
then simple erosive disease of the stomach or duodenum.
CLINICAL PICTURE
• Hematochezia (blood in feces)
• Anemia/ paleness
• Hypovolemia, until shock
• Melena
DIAGNOSIS
• Upper endoscopy: best procedure for diagnosing GI bleeding.
• Angiography
• Enteroscopy
MANAGEMENT
• 85% massive upper GI bleeding is controlled by transfusion and PPI or
significant antacid.
• Epinephrine injection, cauterization, and heater-probe cautery by
endoscopic have been successful in controlling most lesions, if
endoscopist is able to identify a bleeding vessel.
• 10-15% require surgical intervention. The criterion: need 4-6 units of
blood transfusion.
• 5-10% in unidentified etiology of GI bleeding, therapy becomes
supportive, with intermittent blood replacement & continuing
diagnostic efforts.
COURSE AND PROGNOSIS

• Mortality from acute GI bleeding

ranges from 5-12%,
• When the bleeding is stopped, the
prognosis for the patient is good.
Therapeutic
endoscopy
BENIGN TUMORS OF THE STOMACH
EPIDEMIOLOGY
• Benign tumors of the stomach are relatively
rare.
• Gastric polyps found in 0.1% of gastric
specimens.
• Epithelial origin: hyperplastic, fundic gland,
adenomatous polyps.
• Submucosal: leiomyomas, lipomas, fibromas,
fibromas, hamartomas, hemangiomas,
neurofibromas, gastrointestinal stromal
tumors (GISTs), eosinophilic granulomas, and
inflammatory polyps.
• Ectopic: pancreatic rests or Brunner gland
hyperplasia.
CLINICAL PICTURE
• Benign tumors are asymptomatic and are identified on radiography or
endoscopy.
• May be associated with bleeding or obstructive phenomena.
• Severe, acute bleeding may occur with a lipoma that has a surface
erosion and an active bleeding vessel on the surface.
• A rare presentation is gastric outlet obstruction caused by prolapse of
a large polyps into the abdomen.
DIAGNOSIS
• Radiography, barium contrast, or CT scan to identify the lesion.
• Endoscopy for biopsy.
• Endoscopic ultrasound (EUS) to evaluate the depth of the lesion.
TREATMENT & PROGNOSIS
• Small lesions require no further therapy.
• 10% adenomas will develop into adenocarcinoma. Size > 2cm is
associated with malignancy. These polyps should be removed.
• Gastrointestinal stromal tumors, often not diagnosed until the fifth or
sixth decade of life, thus should be removed when it’s possible to
identify.
• Hamartomas, associated with Peutz-Jeghers syndrome, should be
monitored for its progessivity.
GASTRIC LYMPHOMA AND MUCOSA-ASSOCIATED
LYMPHOID TISSUE
Gastric lymphoma &
MALT
• B-Cell lymphoma of the
mucosa-associated
lymphoid tissue (MALT)
• Diffuse, large B-cell
lymphoma.
B-CELL LYMPHOMA OF THE MUCOSA-ASSOCIATED
LYMPHOID TISSUE (MALT)

• Gastric tissue acquires MALT in the pathologic response to

Helicobacter pylori infection. MALT type related to H. pylori infection.
• The MALT type represents 40% of gastric lymphomas. Often located
in the antrum, but in 33% patients can be multifocal.
• Clinical pictures: epigastric pain, or dyspepsia. Nausea, bleeding or
weight loss.
• Diagnostic: endoscopic visualization and tissue biopsy. CT abdomen,
pelvis, chest, and bone marrow puncture analysis for the staging. LDH
in MALT type lymphoma usually normal, and elevated in other
lymphomas.
B-CELL LYMPHOMA OF THE MALT

• Treatment:
- Stage 1  antibiotic eradication of H. pylori,
in 1-2 mo eradication should be established,
endoscopy evaluation after.
- Endoscopic
-
CANCERS OF THE STOMACH