14 - GI bleeding Flashcards
haematemesis
vomiting blood
thick dark clotty
malaena
black thick bloody stool
mallory-weis tear
oesophageal tearing at sphincter of stomach
outline treatment for resuscitation of a GI bleed
ABC
airway protection
oxygen
iv access
fluids
the 100 rule
systolic <100mmHg pulse >100/min Hb<100g/l age>60 cormorbid disease postural drop in bp
young people
diabetics
beta blockers
in gi bleeding haemorrhage, what is observed in each group
young - can compensate great loss, then crash
diabetics - poor autonomic response
- no tachycardia, may seem better but worse
beta - same, no tachycardi
blatchford score
admission risk marker blood Hb (men/wmen) systolic bp others
3 observations likely to find iin a recent haemorrhage
active bleeding
overlying clot
visible vessel (nipple)
most beneficial endoscopic for homeostasis acheivement
adrenaline injected
heat probe coagulation
hemospray may be used to assist, wwhat does it do
powder absorbs water, forming an immediate clot
post endoscopy, what would be give n
acid suppresion (PPI) IV omeprazole
2nd endoscopy doesnt stop bleeding, what is given
IR or surgery
likely cause of varices
liver disease
- cirrhotics with varices will bleed <2yrs (20-40%)
associated risk factors increasing chances of variceal bleeding
portal pressure >12mmHf
varices >25% oesophageal lumen
presence of red signs
degree liver failure (childs A<b></b>
what would cause suspicion of varices
History :
- chronic alcohol excess
- chronic viral hepatitis infection
- metabolic/autoimmune liver disease
- intra-abdominal sepsis/surgery
stigmatas of liver disease
what are stigmatas of chronic liver disease
spider naevi palmar erythema leukonychia ascites jaundice encephalopathy (liver flap) (cant draw star)
aims of management for variceal bleeding
resuscitation
haemostasis
prevent complicationg of bleeding /deterioation of liver function
prevent early re-bleeding
cirrhosis - initial considerations
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
haemostatis for variceal bleeding is achieved by
terlipressin (vasopressin) endoscopic variceal ligation (banding) sclerotherapy (sometimes - if fibrosis) sengstaken-blakemore balloon (tamponade at gastro-oesophageal junction TIPS - decompresses portal venous system
if bleeding stops in variceal bleeding,, what is given
propanolol
banding programme
if bleeding continues in variceal nleed, what is given
EVL or S-B tube
bleed continues
- TIPS
if still bad, transplant
