The aim of this topic is to review the pathophysiology of conditions causing acute and chronic upper gastrointestinal bleeding.

At the completion of this topic you should be able to:

Describe the normal mucosal protective mechanisms in the gastrointestinal tract.
Describe the clinical features which suggest the site and severity of gastrointestinal bleeding.
Discuss the pathogenesis of important causes of acute upper gastrointestinal haemorrhage, including erosive gastritis, ruptured gastro-oesophageal varices, Mallory-Weiss tears and peptic ulcers. Recognise that any of the listed conditions may be the cause of haematemesis in a chronic alcoholic.
Explain the aetiological role of Helicobacter pylori in gastritis, peptic ulceration and gastric carcinoma.
Outline the complications of chronic peptic ulcers.
List factors predisposing to the development of gastric carcinoma.
Describe the clinical presentation and mode of spread of gastric carcinoma.
Discuss the advantages of endoscopy in the management of upper gastrointestinal haemorrhage.

Trial exam questions:

List the common causes of haematemesis. What abnormalities might you find at autopsy following death due to massive blood loss?
Outline the factors that may predispose to peptic ulceration, and discuss the proposed pathogenetic mechanisms.