Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 Academic Weeks > A3- Lower + Upper GI Bleeding > Flashcards

A3- Lower + Upper GI Bleeding Flashcards

1
Q

WHat is GI Bleeding

A

• Blood loss originating from any point of GI tract (mouth to anus).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is lower GI bleed

A

• Blood loss originating from site distal to ligament of Treitz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is upper GI bleed

A

• Blood loss originating from site proximal to ligament of Treitz.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Melaena?

A

• Black tarry faeces that are associated with UGI bleeding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is haematemesis

A

• Vomiting of blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Haematochezia?

A

• Passage of maroon or bright red blood or blood clots per anus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Ligament of Treitz

A

Defines the bend between the duodenum from the jejunum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

WHat does occult lower GI bleeding mean

A

it is a classificaiton

patients usually present with anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do you ask about the blood

A

Colour: •Bright red • Dark red, maroon • Clots

Consistency: • Tarry, sticky • Jelly like • Fluid

Smell: • Fresh blood •Altered digested blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What to ask in history of compliant? bleeding

A

When

How long/how often/how often

abdominal pain

associated symptoms

weight loss, red flag symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PMHx

what to look out for in bleedign

A

IHD, angina

Diverticular disease

Haematological disorders

Surgical Hx

Recent travel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What medicaiton do we need to know about in relation to GI bleedign

A

Anticoagulants

iron tablets

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What to look out for in social hx?

A

alcohol

smoking

fitness assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

WHat to look out for in skin, neurology and abdomen for patient with GI bleeding

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Differential diagnosis

for GI bleedign

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management of ccult to moderate LGI bleed

A

Ensure patient is haemodynamically stable

History and examination (DRE and proctoscopy)

Biochemistry: Full blood count, iron studies, faecal calprotectin

Imaging: Flexible sigmoidoscopy, colonoscopy, CT colonography, CT abdomen, MRI abdomen

Referral to tertiary care – ? Capsule (VCE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of massive LGI bleed

A

Main principles are

  1. resuscitate 2. stop the bleeding
18
Q

WHat do score do you use to check if the patient is safe to be discharged after a lower GI bleed

A

Oakland Score

19
Q

What components do you look at in th eoakland score?

A
20
Q

What is the resuscitation principles for GI bleed

A
  • Enlist help and escalate early.
  • X2 large bore cannulae.
  • Bloods for crossmatch.
  • Fluid resuscitation with crystalloid first then think blood.
  • Remember massive transfusion protocol.
  • Monitor urine output.
  • Reverse anticoagulation if possible
  • TXA
21
Q

what is the Massive transfusion Protocol?

A
22
Q

Significance of colonoscopy?

A
  • Can be diagnostic of all sources of bleeding.
  • Efficient and cost effective.
  • Can have therapeutic possibilities.

Cons:

  • Less useful in major bleed.
  • Good views require bowel prep.
  • Invasive.
  • Difficult to complete out of hours.
23
Q

What is the Sensitivity and Specificity of CT angiography

A

Sensitivity 86%

Specificity 95%

24
Q

Pros and Cons of Mesenteric angiography

A
  • No bowel prep required. • Therapeutic possibilities with high accuracy and localisation.
  • Requires active bleeding. • Less sensitive to venous bleeds (need prolonged exposure times). •Invasive therefore potential complications.
25
Q

Pros and COns of Radionuclide Scintigraphy

A
  • Label red blood cells detect the slowest bleeding rate 0.1- 0.5mL/min but cannot reliably localise site of bleeding. • Non invasive. • No bowel prep. • Repeatable investigation.
  • Non therapeutic. • May delay intervention. • Diagnosis has to be confirmed by other means
26
Q

Significance of capsule endoscopy?

A
  • Can identify small bowel bleeding sites
  • Role in active bleeding to be defined.
27
Q

If surgery is done

known source is called

unknown source is called

A
  • If known source –selective colectomy.
  • If unknown source – on table endoscopy +/- subtotal colectomy
28
Q

Common Upper GI bleeds?

A
29
Q

In the “other/no obvious cause” category for upper GI bleed

examples?

A
  • Angiodysplasia
  • Gastric antral vascular ectasia (GAVE)
  • Dieulafoy lesion
  • Hereditary haemorrhagic telangiectasia (HHT)
  • Portal hypertensive gastropathy
  • Aorto-duodenal or Aorto-enteric fistula
30
Q

What is the (Glasgow) Blatchford Score

A

Assessment tool to be done to aid decision for when endoscopy
should be performed
➢ Score of 0-2

31
Q

What is the score called where you are Establishing severity, likelihood, and mortality

A

Rockall Score

32
Q

How do you classify how much blood is lost?

A
33
Q

Initial Management for upper GI bleed

A

•Airway
•Breathing
•Circulation
•Disability
•Exposure
(Don’t Ever Forget Glucose)
(Round you go again)

34
Q

Blood-related investigations for suspected
UGI bleed

A
  • FBC
  • U/E
  • LFTs
  • INR/Coag
  • Blood Gas + Glucose
  • Group and Save Vs Crossmatch Vs Major haemorrhage protocol
35
Q

Management of non-variceal bleed

A

As always these are your options
➢ (Non-pharmacological/pharmacological/conservative)
➢ Endoscopic
➢ Interventional Radiology: angiography and embolisation
➢ Surgical: resection

36
Q

Endoscopic management of non-variceal bleed

A

Three main methods for achieving haemostasis
➢ Adrenaline + Mechanical: Clips
➢ Adrenaline + Thermal coagulation: heat probes, argon plasma
➢ Adrenaline + Fibrin or thrombin: Haemospray

37
Q

Post-endoscopy intervention: Pharmacological treatment

A

1) Existing medication
• Education on NSAID use
• Decide risk vs benefit for anticoagulation, when to restart/ should we restart

2) Eradication
• H. pylori eradication

3) Hong Kong Regime for PPI
• 80mg Omeprazole stat + 8mg/hour over 72 hours
4) Rescope

38
Q

What is the Child-Pugh Score

A

he Child-Pugh score is a system for assessing the prognosis — including the required strength of treatment and necessity of liver transplant — of chronic liver disease, primarily cirrhosis. It provides a forecast of the increasing severity of your liver disease and your expected survival rate.

39
Q

Management of acute Variceal Bleed At presentation

A

➢ Fluid resus (blood vs saline vs gelofusin vs HAS)
➢ Terlipressin (2mg IV 4 hourly)
➢ Prophylactic antibiotic therapy (Broadspectrum)
At endoscopy
➢ Band ligation
➢ N-butyl-2-cyanoacrylate

40
Q

Management post endoscopy (variceal)

A
  • Fluid replacement – preferably 4.5% HAS
  • Terlipressin: stop after definitive treatment has been achieved
  • Pabrinex (I + II) 2 pairs TDS
  • (Do not confuse with “Parvolex”)
  • Laxatives (prevents encephalopathy)
  • Re-scope to assess bands
  • Varices surveillance
41
Q
A

Year 3 Academic Weeks (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions