14 - GI bleeding

Question 1

haematemesis

Answer 1

vomiting blood

thick dark clotty

Question 2

malaena

Answer 2

black thick bloody stool

Question 3

mallory-weis tear

Answer 3

oesophageal tearing at sphincter of stomach

Question 4

outline treatment for resuscitation of a GI bleed

Answer 4

ABC

airway protection
oxygen
iv access
fluids

Question 5

the 100 rule

Answer 5

systolic <100mmHg
pulse >100/min 
Hb<100g/l
age>60
cormorbid disease
postural drop in bp

Question 6

young people
diabetics
beta blockers

in gi bleeding haemorrhage, what is observed in each group

Answer 6

young - can compensate great loss, then crash

diabetics - poor autonomic response
- no tachycardia, may seem better but worse

beta - same, no tachycardi

Question 7

blatchford score

Answer 7

admission risk marker 
blood 
Hb (men/wmen)
systolic bp 
others

Question 8

3 observations likely to find iin a recent haemorrhage

Answer 8

active bleeding
overlying clot
visible vessel (nipple)

Question 9

most beneficial endoscopic for homeostasis acheivement

Answer 9

adrenaline injected

heat probe coagulation

Question 10

hemospray may be used to assist, wwhat does it do

Answer 10

powder absorbs water, forming an immediate clot

Question 11

post endoscopy, what would be give n

Answer 11

acid suppresion (PPI)
IV omeprazole

Question 12

2nd endoscopy doesnt stop bleeding, what is given

Answer 12

IR or surgery

Question 13

likely cause of varices

Answer 13

liver disease

- cirrhotics with varices will bleed <2yrs (20-40%)

Question 14

associated risk factors increasing chances of variceal bleeding

Answer 14

portal pressure >12mmHf
varices >25% oesophageal lumen
presence of red signs
degree liver failure (childs A<b></b>

Question 15

what would cause suspicion of varices

Answer 15

History :

• chronic alcohol excess
• chronic viral hepatitis infection
• metabolic/autoimmune liver disease
• intra-abdominal sepsis/surgery

stigmatas of liver disease

Question 16

what are stigmatas of chronic liver disease

Answer 16

spider naevi
palmar erythema 
leukonychia 
ascites
jaundice
encephalopathy (liver flap) (cant draw star)

Question 17

aims of management for variceal bleeding

Answer 17

resuscitation
haemostasis
prevent complicationg of bleeding /deterioation of liver function
prevent early re-bleeding

Question 18

cirrhosis - initial considerations

Answer 18

often coagulopathic (platelets low/dysfunction)
low in vitK
CVP monitoring (central venous pressure - portal pressure may incr tooo much)
parenteral vitamins
antibiotics
hypoglycaemia
replace K,Mg,PO4

Question 19

haemostatis for variceal bleeding is achieved by

Answer 19

terlipressin (vasopressin)
endoscopic variceal ligation (banding)
sclerotherapy (sometimes - if fibrosis)
sengstaken-blakemore balloon (tamponade at gastro-oesophageal junction 
TIPS - decompresses portal venous system

Question 20

if bleeding stops in variceal bleeding,, what is given

Answer 20

propanolol

banding programme

Question 21

if bleeding continues in variceal nleed, what is given

Answer 21

EVL or S-B tube
bleed continues
- TIPS
if still bad, transplant