Acute and Chronic GI Bleeding Flashcards
What are the cardinal features of acute upper GI bleeding?
Haematemesis
Malaena
What is malaena?
The passage of black tarry stools
What is the passage of dark blood and clots without shock almost always due to?
Lower GI bleeding
What is the most common cause of serious GI bleeding?
Peptic ulceration
What are the GI side effects of aspirin and NSAIDs?
Ulcers and erosions
GI haemorrhage from duodenal and gastric ulcers
What are the common causes of acute upper GI bleeding?
Drugs Alcohol Reflux oesophagitis Varices (gastric and oesophageal) Mallory-Weiss syndrome Gastric adenocarcinoma Hemorrhagic gastropathy and erosions
Which factors affect the risk of re-bleeding and death?
Age Evidence of co-morbidity Presence of the classical clinical features of shock Endoscopic diagnosis Endoscopic stigmata of recent bleeding Clinical signs of chronic liver disease
What are the classical clinical features of shock?
Pallor
Cold peripheries
Tachycardia
Low blood pressure
What is the immediate management for acute GI bleeding?
Take blood for Hb, U&Es, LFTs, coagulation screen, group and crossmatching
Establish IV access and give blood transfusion if in shock or Hb<100 g/L
Give oxygen therapy
Perform urgent endoscopy in shocked patients or liver disease
Continue to monitor pulse and Bp, re-endoscope if bleeding continues, arrange surgery if bleeding persists
In management of acute GI bleeding, how may medication need to be altered?
Stop NSAIDs, aspirin, clopidogrel and warfarin
What pieces of information are guides to the adequacy of a blood transfusion?
Pulse rate
Venous pressure
What are the stigmata of recent bleeding that can be seen on endoscopy?
Spurting vessel
Active oozing
Fresh or organised blood clot or black spots
How are varices treated?
Usually banding
Stenting can also be used but is not widely available
How are bleeding ulcers and those with the stigmata of recent bleeding treated?
Two or three haemostatic measures:
Injection with adrenaline and thermal coagulation or endoscopic clipping
What drug therapy should be given to patients with actively bleeding ulcers or ulcers with a visible vessel?
PPIs
What is a Mallory-Weiss tear?
A tear in the gastro-oesophageal junction produced by a sudden increase in intra-abdominal pressure
How is a chronic peptic ulcer treated?
Eradication of H. pylori
PPI for 4 weeks
if eradication not achieved - long term acid suppression
If bleeding not controlled - angiography and embolisation or surgery
What is acute lower GI bleeding usually due to?
Diverticular disease or ischaemic colitis
What are common causes of small acute lower GI bleeds?
Haemorrhoids
Anal fissures
What are the causes of acute lower GI bleeding?
Meckel's diverticulum Carcinoma Diverticula Angiodysplasia Ischaemic colitis Polyps IBD Haemorrhoids
What are the main investigations for acute lower GI bleeding?
Proctoscopy
Flexible sigmoidoscopy or colonoscopy
Video capsule endoscopy
Angiography
What is a proctoscopy used to diagnose?
Anorectal disuse, particularly haemorrhoids
What is a flexible sigmoidoscopy or colonoscopy used to diagnose?
IBD Cancer Ischaemic colitis Diverticular disease Angiodysplasia
What is an angiography used to diagnose?
Vascular abnormality
Yield is low so usually a last resort
What do isolated bleedings in the young usually require?
Rectal exam and flexible sigmoidoscopy
What do patients with chronic GI bleeding usually present with?
Iron deficiency anaemia
What is the primary concern in chronic GI bleeding?
To exclude carcinoma
What is the most common worldwide cause of chronic GI blood loss?
Hookworm
What are the usual investigations for chronic GI blood loss?
Upper GI endoscopy
Colonoscopy
Unprepared CT
CT colonoscopy
When is an upper GU endoscopy used in chronic GI blood loss?
Usually first
Take duodenal biopsy for coeliac disease, even if serology already performed
When is a colonoscopy used in chronic GI blood loss?
The next investigation after upper GI endoscopy
Any lesion should be biopsied or removed
When is an un prepared CT used in chronic GI blood loss?
As a reasonable test to look for colon cancer in frail patients
When is a CT colonoscopy used in chronic GI blood loss?
Can be used as an alternative to colonoscopy
What is the investigation of choice to examine the small bowel in chronic GI blood loss?
Capsule endoscopy
How can bleeding lesions in the small bowel be treated?
Balloon-assisted enteroscopy
What may be used to demonstrate a potential bleeding site in a Meckel’s diverticulum?
IV technetium-labelled colloid
