3. Acute gastro-intestinal bleed

Question 1

How common is it?

Answer 1

Common medical emergency

Upper GI bleed is more common than lower

Question 2

Who does it affect?

Answer 2

M>F
All ages - elderly have a worse prognosis
Those with peptic ulcers, oesophago-gastric varices (U)
Haemorrhoids and angiodysplasia (L)

Question 3

What causes it?

Answer 3

Depends on preceding conditions
Peptic ulcers, oesophageal tears, varices, oesophagitis (U)
Diverticular disease, IBD, tumours, polyps, anal fissures, haemorrhoids (L)

Question 4

What risk factors are there?

Answer 4

Having preceding GI pathology (+smoking, NSAIDs etc)

Increasing age

Question 5

How does it present?

Answer 5

Overt - vomiting blood, black, tarry stool, rectal bleeding

Occult - lightheadedness, difficulty breathing, fainting, chest + abdo pain

Question 6

What signs might the patient have on examination?

Answer 6

Shock - hypotensive, bradycardic, oliguria, unconscious

Signs of anaemia

Question 7

What other conditions might present similarly?

Answer 7

Lower GI bleeds may be mistaken for upper and vice versa

Question 8

What treatments are there?

Answer 8

Most settle spontaneously (L)
Unstable bleeds require urgent resuscitation
Transfusion
Endoscopic haemostasis, arterial embolisation