6. GI bleeding Flashcards
What are the symptoms of acute gastrointestinal hemorrhage?
Symptoms include
- hematemesis (fresh blood, coffee ground),
- melena,
- hematochesia,
- occult bleeding,
- anemia.
What is the most common cause of upper GI hemorrhage?
The most common cause of upper GI hemorrhage is peptic ulcer bleeding (~50%).
What are some causes of lower GI bleeding?
Causes of lower GI bleeding include
- diverticulosis,
- polyp,
- cancer,
- inflammation,
- ischemia,
- iatrogenic (polypectomy),
- vasculitis.
What are some symptoms of lower GI bleeding?
Symptoms of lower GI bleeding include anemia, melena, and hematochesia.
What are the possible causes of upper gastrointestinal hemorrhage?
Possible causes of upper gastrointestinal hemorrhage include
- variceal bleeding
- non-variceal bleeding : peptic ulcer, erosive lesions, Mallory-Weiss syndrome, cancer…
What are the symptoms of upper gastrointestinal hemorrhage?
Symptoms of upper gastrointestinal hemorrhage include
- anemia,
- melena,
- hematemesis, (+/- hematochezia)
What are the possible causes of peptic ulcer bleeding?
- H. Pylori,
- NSAIDs,
- anticoagulants,
- platelet aggregation inhibitors
What are the clinical features of peptic ulcer bleeding?
Clinical features of peptic ulcer bleeding include
- epigastric pain,
- dyspepsia,
- fatigue,
- melena,
- hematemesis
- hematochezia.
What are the possible laboratory tests used to assess upper gastrointestinal hemorrhage?
- blood count,
- minerals,
- BUN,
- creatinine,
- prothrombin.
What is the recommended therapy for high-risk patients in upper gastrointestinal bleesing?
- Early or emergency upper GI endoscopy
- Intravenous proton pump inhibitor therapy with a bolus followed by continuous infusion if needed.
- Second endoscopic treatment, with radiology or surgery if needed
What is the recommended management for patients with cardiovascular disease who develop upper gastrointestinal bleeding?
Start proton pump inhibitor therapy and reinstitute antiplatelet therapy (aspirin) as soon as possible.
What is the Forrest classification used for?
It is used to classify the endoscopic appearance of bleeding ulcers.
What is the recommended timing for endoscopy in stable, mild to moderate risk patients with upper gastrointestinal bleeding?
Early endoscopy (<24h).
What is the recommended timing for endoscopy in high-risk, unstable patients with upper gastrointestinal bleeding despite resuscitation?
Emergency endoscopy (<12h).
What is the recommended treatment for active bleeding ulcers (Forrest classification Ia or Ib)?
Combination of epinephrine injection with a second hemostasis modality (contact thermal, mechanical therapy, or injection of a sclerosing agent).
What is the recommended treatment for non-bleeding visible vessel ulcers (Forrest classification IIa)?
- Mechanical therapy (hemoclip),
- thermal therapy (coagulation),
- injection of a sclerosing agent as monotherapy / in combination with epinephrine injection.
What is the recommended treatment for adherent clot ulcers (Forrest classification IIb)?
Endoscopic clot removal should be considered.
What is the mechanism of action of epinephrine injection in the treatment of bleeding ulcers?
It causes vasoconstriction and reduces blood flow to the bleeding site.
What should be done for any identified underlying active bleeding (Forrest Ia., Ib.) or non-bleeding visible vessel (Forrest IIa.) during endoscopy?
It should receive endoscopic hemostasis.
What is the Glasgow-Blatchford Score?
It is a scoring system used to predict the need for medical intervention in patients with upper gastrointestinal bleeding.
What is the purpose of the rapid urease test during endoscopy?
It is used to detect the presence of Helicobacter pylori bacteria in the stomach lining.
What is the incidence of variceal bleeding in all upper GI bleedings?
5-20%.
What is the mortality rate of variceal bleeding?
~20%.
What is the etiology of variceal bleeding?
Portal hypertension (pre-sinusoidal, sinusoidal, post-sinusoidal).
What are the signs of variceal bleeding?
Epigastric discomfort, dyspepsia, fatigue.
What are the symptoms of variceal bleeding?
- Hematemesis,
- melena-haematochezia,
- anemia,
- hypovolemia,
- signs of chronic liver disease.
What examinations are done to diagnose variceal bleeding?
- Physical state,
- laboratory : blood-count, electrolytes, liver function test, prothrombin, BUN, creatinine.
What is the vasoactive therapy for variceal bleeding?
- terlipressin (IV - 2mg)
- octreotide (IV)
- somatostatin (IV)
What is the guideline for managing variceal bleeding?
Endoscopic ligation
When should prothrombin complex concentrate be administered for variceal bleeding?
For active bleeders taking vitamin K antagonist.
What is the recommended for cirrhotic patients with suspected upper GI bleeding?
Antibiotic prophylaxis : oral or IV quinolone, or 3rd generation cephalosporin IV for 5-7 days.
What is the recommended pre-endoscopy infusion for upper GI bleeding?
Erythromycin (250mg IV 30-120 min before).
What is the effect of terlipressin on variceal pressure?
Rapid decrease of variceal pressure after a couple of minutes
What should be done if endoscopic therapy fails to control bleeding?
Balloon tamponade should be performed to temporarily control bleeding until more definitive therapy.
What is the maximum duration for which balloon tamponade should be maintained?
Balloon tamponade should not be maintained for more than 24 hours.
What is the recommended time frame for TIPS in cases of refractory variceal bleeding?
Emergency (<24 hours) or early (<72 hours) for therapeutic success.
What may be considered in cases of refractory variceal bleeding?
The use of self-expandable covered metal stents (SEMS) may be considered.
What is the surgical treatment for refractory variceal bleeding?
- Porto-caval anastomosis
- self expanding metal stents may be considered
What is the purpose of endoscopic variceal ligation (EVL)?
- secondary prophylaxis of rebleeding
- may be used in primary prophylaxis (M/L varices).
What are the risk factors for lower GI bleeding?
- Anticoagulants,
- NSAID,
- comorbidity.
What are the signs of lower GI bleeding?
- Discomfort,
- pain,
- fatigue.
What are the symptoms of lower GI bleeding?
- Melena,
- hematochesia,
- anemia (collapse).
What are the etiologies of lower GI bleeding?
- Diverticulosis,
- ischemic colitis,
- angiectasia,
- hemorrhoids,
- polyps/neoplasia,
- iatrogenic (polypectomy, dilatation),
- IBD,
- infectious colitis,
- vasculitis.
What are the guidelines for lower GI bleeding management?
- Colonoscopy,
- endoscopic hematostasis (in case of high risk of bleeding)
What is small bowel bleeding?
Bleeding that occurs in the jejunum or ileum, which are parts of the small intestine.
What is the first-line procedure for diagnosing small bowel bleeding?
- Excluding upper and lower GI bleeding first
- Video capsule endoscopy (VCE)
- Deep enteroscopy
What is the advantage of CT enterography in diagnosing small bowel bleeding?
CT enterography has the advantage of locating masses.
What is Hemospray powder?
Hemospray powder is a highly adsorptive powder that becomes cohesive and forms a stable mechanical plug.
What is endoscopic suturing?
Endoscopic suturing is arguably the most secure form of hemostasis.
