Abdominal: acute-gastrointestinal bleed Flashcards
what are common causes of a upper GI bleed?
- peptic ulcers
- mallory-weiss tear
- gastric erosions
- drugs; NSAIDs, aspirin, steroids, thrombolytics, anticoagulants
- Oesophagitis
- Duodenitis
- Malignancy
what are common causes of a lower GI bleed?
- diverticular disease
- inflammatory bowel disease (IBD)
- Tumours (benign and cancerous)
- colon polyps
- haemorrhoids
- anal fissures
- proctitis
what are the risk factors for a GI bleed?
- age
- co-mobidity e.g. cardiac failure, ischaemic heart disease, malignancy
- shock
- mallory-weirs tear
- peptic ulceration
what are clinical features of an upper GI bleed?
- haematemesis
- melaena
Gastrointestinal (GI) bleeding may be classified as overt, obscure, or occult. What does each mean?
Overt - visible blood to patient/physician
Obscure - recurrent bleeding in which a source is not identified
Occult - blood not visible to patient/physician
what is hematochezia?
blood/blood clots in the stool
what is melena?
black tarry stools
what are some clinical features of occult bleeding?
- Lightheadedness
- Difficulty breathing
- Fainting
- Chest pain
- Abdominal pain
what is the emergency management of a GI bleed?
- history and examination
- monitor pulse and BP half hourly
- blood test/FBC
- establish IV access for blood transfusion if patient is to go into shock or has haemoglobin <100g/L
- oxygen
- urgent endoscopy in shocked patients/liver disease
- surgery if bleeding persists
how do you manage a patient with an acute upper GI bleed?
- stop NSAIDs/aspirin, clopidogrel and warfarin if patients are taking them.
- give oxygen
- keep pt nil by mouth until endoscopy has been performed
- major principle is to rapidly restore blood volume to normal (transfusion)
why must a blood transfusion be monitored?
to avoid overload leading to heart failure
NB: pulse rate and venous pressure are best indicators.
how do you manage a patient with an acute lower GI bleed?
Most lower GI bleeds stop and start spontaneously, if The few patients who continue bleeding and are haemodynamically unstable need resuscitation using the same principles as for upper GI bleeding.
what medication is offered for a GI bleed?
After diagnosis at endoscopy, intravenous omeprazole 80 mg followed by infusion 8 mg/h for 72 hours should be given to all patients with actively bleeding ulcers or ulcers with a visible vessel, as it reduces rebleeding rates.
what are the complications of GI bleeds?
Shock, anemia, death
