Bleeding Lesions in the Stomach | Medibuddy
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17th July 2023

Bleeding Lesions in the Stomach

Bleeding gastric lesions, which are commonly tested in the MRCP examination, are listed in table 10.

Lesion Details
Peptic ulcer Breaks in the mucosal layer can penetrate down the muscularis mucosa of the stomach and duodenum.

They are associated with burning epigastric pain.

  • GUs are most often seen on the lesser curvature of the stomach. The arterial supply to this area is the left gastric artery.
Gastric varices Can occur secondary to portal hypertension. Causes:

  • Liver cirrhosis
  • Non-cirrhotic portal hypertension
    • Venous thrombosis (portal vein/splenic vein/hepatic vein = Budd-Chiari)
    • Cardiac (constrictive pericarditis, restrictive cardiomyopathy)
    • Schistosomiasis
    • Idiopathic non-cirrhotic portal hypertension
Erosive gastritis Multiple erosions seen in the gastric mucosa.

Causes: H. pylori, medication (steroids, NSAIDs), alcohol.
Gastric neoplasms Gastric adenocarcinoma – most often found in the cardia

Gastrointestinal stromal tumours (GISTs)

Neuroendocrine tumours

Gastric lymphomas
Dieulafoy’s lesion Vascular malformations where aberrant tortuous arterioles can erode through the submucosal layer and cause bleeding. They account for 5% of UGIB.
Gastric Antral Vascular Ectasia (GAVE) An uncommon cause of chronic gastric bleeding caused by fragile antral vessels.

Question clue: the classic ‘watermelon stomach’ appearance described on endoscopy.
Zollinger-Ellison Syndrome (ZES) Gastrin producing tumours (gastrinomas) secrete excess gastrin in the duodenum and pancreas. Suspicion for ZES should be raised in cases of multiple peptic ulcers, ulcers in the jejunum, ulcers that are non-responsive to PPI therapy. 20% of patients have MEN-1.

Investigation:

  •  x3 measurements of high fasting gastrin levels
  • Secretin stimulation test in patients with a non-diagnostic fasting gastrin level.

Question clue: diarrhoea + multiple peptic ulcers + not responding to PPIs
Angiodysplasia Small vascular malformations which can be found throughout the GI tract.

Table 10: Bleeding lesions in the stomach

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