๐ฎ๐ฐ ๐ฏ๐๐๐๐๐๐๐๐๐๐ Flashcards
What defines acute GI bleeding?
Bleeding less than 3 days duration with hemodynamic instability requiring blood transfusion
What is the difference between overt and occult GI bleeding?
Overt bleeding is visible (melena/bright red blood) while occult is only detected by lab tests
What percentage of GI bleeds are from upper sources?
75% of GI bleeds originate from upper sources
Which gender has a higher prevalence of upper GI bleeding?
More common in men (2:1 ratio)
What are three main types of ulcers causing upper GI bleeding?
Peptic ulcer duodenal ulcer and gastric ulcer
What is Mallory-Weiss tear?
A superficial longitudinal mucosal tear of the upper esophagus
What causes variceal bleeds in liver cirrhosis?
Portal hypertension leading to porto-systemic anastomosis development
What are the four main vital signs of hemodynamic instability in GI bleeding?
Pulse rate
Respiratory rate
Blood pressure
Mental state
What is the first priority in emergency management of GI bleeding?
ABC (Airway Breathing Circulation) with focus on C takes priority over finding diagnosis/cause
How is crystalloid fluid therapy given in GI bleeding?
3:1 ratio of the blood loss estimated using Ringerโs lactate given over 10-15 minutes
What lab tests should be ordered immediately in GI bleeding?
FBC clotting profile blood grouping and crossmatch
What are the three anatomical sites of lower GI bleeding?
Colon rectum and anus
What percentage of rectal bleeding cases in patients over 80 is due to colon cancer?
10% of cases in patients over 80 years
What is a key physical exam finding in GI bleeding suggesting shock?
Skin signs (color warmth moisture) to assess for shock
What social history factors increase risk of GI bleeding?
Alcoholism (risk of liver disease/variceal bleeding) and smoking (risk of PUD)
What is melena and what does it suggest?
Black tarry stools suggesting upper GI bleed
What color blood suggests rectal/anal source?
Bright red blood per rectum suggests rectal or anal source
What medication history is important in GI bleeding?
Antiplatelet or anticoagulant use that can exacerbate bleeding
What are the three main inflammatory causes of lower GI bleeding?
Colitis
Hemorrhoids
Inflammatory bowel disease
What are the vital signs to monitor during resuscitation?
Pulse rate
Blood pressure
Urine output
Level of consciousness
Temperature
When should you secure IV access in GI bleeding?
Immediately using 2 large-bore cannula in antecubital fossae
What indicates severity in GI bleeding?
Duration frequency and volume of bleeding
What would you like to ask in past medical history for GI bleeding?
โฆ๏ธPrevious GI bleeding
โฆ๏ธHx of ay disease that can cause GI bleeding e.g peptic ulcer disease
โฆ๏ธBleeding disorders
โฆ๏ธDrug hx (anti-coagulants or anti-platelets)
How do you assess severity of blood loss clinically?
By checking vital signs mental status and skin signs
What symptoms suggest upper GI source?
Upper abdominal pain or dyspeptic symptoms
What symptoms suggest lower GI source?
Lower abdominal pain, diarrhea or change in bowel habits
What is the goal of medical therapy in GI bleeding?
To correct shock and stabilize patient for further evaluation
What are the three key findings in abdominal examination for GI bleeding?
โฆ๏ธInspection (spider nevi, abdominal distension)
โฆ๏ธPalpation (tenderness)
โฆ๏ธPercussion (ascites)
What is the timeframe for urgent OGD in upper non-variceal GI bleeding?
Within 24 hours - both diagnostic and therapeutic
What are the four endoscopic treatment options for bleeding?
Injection (adrenaline) alcohol thermoregulation and clipping of bands
What is the role of proton pump inhibitors in GI bleeding?
PPI infusion stabilizes clot by maintaining pH at > 6
What is the role of tranexamic acid in GI bleeding?
Acts as an antifibrinolytic agent to help stabilize clots
Why at are the pharmacological management of non-variceal GI bleeding?
โฆ๏ธProton pump Inhibitors (infusion)
โฆ๏ธTranexemic acid (anti-fibrinolytic)
โฆ๏ธIf H.pylori is positive, Eradication therapy
โฆ๏ธStop NSAIDS/Aspirin/Clopidogrel/Warfarin/Steroids if safe to do so
What medications should be stopped during acute GI bleeding?
NSAIDs, Aspirin, Clopidogrel and steroids if safe to do so
What are the 5 main options for managing variceal bleeds?
โฆ๏ธEndoscopy (within 12 hrs)
โฆ๏ธDrugs (Somatostatin, Terlipressin, Propanolol)
โฆ๏ธBallon Tamponade (Using Sengstaken-blakemore tube)
โฆ๏ธRadiology (TIPSS- Transjugular intrahepatic porto-systemic shunt)
โฆ๏ธSurgical ( Surgical porto-systemic shunts, Oesophageal resection, Splenectomy & gastric devascularization, Liver transplantation)
What is the TIPSS procedure?
Transjugular intrahepatic porto-systemic shunt - is a radiological procedure that creates a shunt between hepatic and portal vein to reduce portal pressure
What are the four main surgical options for variceal bleeding?
โฆ๏ธSurgical porto-systemic shunts
โฆ๏ธOesophageal resection
โฆ๏ธSplenectomy & gastric devascularization
โฆ๏ธLiver transplantation
What is the timing for endoscopy in variceal bleeding?
Within 12 hours of presentation
What endoscopic procedures are used for lower GI bleeding?
โฆ๏ธOesophago-gastro-duodenoscopy
โฆ๏ธColonoscopy
โฆ๏ธRadiotherapy: Colon polyps
โฆ๏ธProctoscopy and flexible sigmoidoscopy
Why is occult blood testing indicated regardless of stool appearance?
To detect hidden bleeding even if stool appears normal
What is the role of CT angiogram in GI bleeding?
Diagnostic only - non-invasive method to identify bleeding source
What surgical options exist for lower GI bleeding?
Segmental colectomy and subtotal colectomy
What physical findings suggest epigastric pain origin?
Tenderness which may indicate peptic ulcer or hepatosplenomegaly
How is endoscopic therapy modified if rebleeding occurs?
Repeat urgent OGD (oesophago-gastro-duodenoscopy)
What is the main indication for surgery in GI bleeding?
Reserved for patients with failed medical management
When should radiotherapy be considered in GI bleeding?
For treating colon polyps when indicated
What are the complications of surgery?
โฆ๏ธAnastomosis bleeding
โฆ๏ธIntra-abdominal bleeding
โฆ๏ธSepsis
โฆ๏ธMechanical small bowel obstruction
4 Clinical features of Upper GI bleeding
โฆ๏ธHematemesis
โฆ๏ธCoffee ground vomit
โฆ๏ธMelena (black tarry stools per rectum)
โฆ๏ธHematochezia
State 5 causes of Upper GI bleeding
โฆ๏ธUlcer: Oesophageal ulcer, Duodenal ulcer, Gastric
โฆ๏ธErosion: Oesophageal, Duodenal, Gastric Erosion
โฆ๏ธMallory Weiss tear
โฆ๏ธ Osophageal varices
โฆ๏ธTumour
Define Lower Gi bleeding
This refers to bleeding distal to the ligament of treitz
What drugs are used in managing variceal bleeding?
โฆ๏ธ Somatostatin
โฆ๏ธTerlipressin
โฆ๏ธPropanolol
