Acute and Chronic GI Bleeding Flashcards

1
Q

What are the cardinal features of acute upper GI bleeding?

A

Haematemesis

Malaena

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2
Q

What is malaena?

A

The passage of black tarry stools

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3
Q

What is the passage of dark blood and clots without shock almost always due to?

A

Lower GI bleeding

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4
Q

What is the most common cause of serious GI bleeding?

A

Peptic ulceration

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5
Q

What are the GI side effects of aspirin and NSAIDs?

A

Ulcers and erosions

GI haemorrhage from duodenal and gastric ulcers

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6
Q

What are the common causes of acute upper GI bleeding?

A
Drugs
Alcohol
Reflux oesophagitis
Varices (gastric and oesophageal)
Mallory-Weiss syndrome
Gastric adenocarcinoma
Hemorrhagic gastropathy and erosions
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7
Q

Which factors affect the risk of re-bleeding and death?

A
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
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8
Q

What are the classical clinical features of shock?

A

Pallor
Cold peripheries
Tachycardia
Low blood pressure

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9
Q

What is the immediate management for acute GI bleeding?

A

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

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10
Q

In management of acute GI bleeding, how may medication need to be altered?

A

Stop NSAIDs, aspirin, clopidogrel and warfarin

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11
Q

What pieces of information are guides to the adequacy of a blood transfusion?

A

Pulse rate

Venous pressure

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12
Q

What are the stigmata of recent bleeding that can be seen on endoscopy?

A

Spurting vessel
Active oozing
Fresh or organised blood clot or black spots

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13
Q

How are varices treated?

A

Usually banding

Stenting can also be used but is not widely available

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14
Q

How are bleeding ulcers and those with the stigmata of recent bleeding treated?

A

Two or three haemostatic measures:

Injection with adrenaline and thermal coagulation or endoscopic clipping

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15
Q

What drug therapy should be given to patients with actively bleeding ulcers or ulcers with a visible vessel?

A

PPIs

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16
Q

What is a Mallory-Weiss tear?

A

A tear in the gastro-oesophageal junction produced by a sudden increase in intra-abdominal pressure

17
Q

How is a chronic peptic ulcer treated?

A

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

18
Q

What is acute lower GI bleeding usually due to?

A

Diverticular disease or ischaemic colitis

19
Q

What are common causes of small acute lower GI bleeds?

A

Haemorrhoids

Anal fissures

20
Q

What are the causes of acute lower GI bleeding?

A
Meckel's diverticulum
Carcinoma
Diverticula
Angiodysplasia
Ischaemic colitis
Polyps
IBD
Haemorrhoids
21
Q

What are the main investigations for acute lower GI bleeding?

A

Proctoscopy
Flexible sigmoidoscopy or colonoscopy
Video capsule endoscopy
Angiography

22
Q

What is a proctoscopy used to diagnose?

A

Anorectal disuse, particularly haemorrhoids

23
Q

What is a flexible sigmoidoscopy or colonoscopy used to diagnose?

A
IBD
Cancer
Ischaemic colitis
Diverticular disease
Angiodysplasia
24
Q

What is an angiography used to diagnose?

A

Vascular abnormality

Yield is low so usually a last resort

25
What do isolated bleedings in the young usually require?
Rectal exam and flexible sigmoidoscopy
26
What do patients with chronic GI bleeding usually present with?
Iron deficiency anaemia
27
What is the primary concern in chronic GI bleeding?
To exclude carcinoma
28
What is the most common worldwide cause of chronic GI blood loss?
Hookworm
29
What are the usual investigations for chronic GI blood loss?
Upper GI endoscopy Colonoscopy Unprepared CT CT colonoscopy
30
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
31
When is a colonoscopy used in chronic GI blood loss?
The next investigation after upper GI endoscopy | Any lesion should be biopsied or removed
32
When is an un prepared CT used in chronic GI blood loss?
As a reasonable test to look for colon cancer in frail patients
33
When is a CT colonoscopy used in chronic GI blood loss?
Can be used as an alternative to colonoscopy
34
What is the investigation of choice to examine the small bowel in chronic GI blood loss?
Capsule endoscopy
35
How can bleeding lesions in the small bowel be treated?
Balloon-assisted enteroscopy
36
What may be used to demonstrate a potential bleeding site in a Meckel's diverticulum?
IV technetium-labelled colloid