Acute Gastro-Intestinal Bleed

Question 1

What are the symptoms of an Upper GI bleed?

Answer 1

• haematemesis (bright red or coffe ground)
• Malaena
• dizziness
• light headed
• collapse

Question 2

What are the signs of a GI bleed?

Answer 2

• Shock (if severe) (low BP, fast pulse, high resp rate)
• malaena (on PR)
• haematemasis
• Peripherally shut down (Cap refill <2s, reduced urine output)
• look for signs of liver disease (oesophageal varices)

Question 3

What are the common causes of an acute GI bleed?

Answer 3

• peptic ulcer
• Mallory weiss tear
• Oesophageal varices
• Gastritis / gastric erosions
• Drugs (NSAIDs, Aspirin, Steroids, Thrombolytics, anticoagulants)
• Oesophagitis
• duodenitis
• ## malignancy

Question 4

What drugs can increase the risk of a GI bleed?

Answer 4

• NSAIDs
• Aspirin
• Steroids
• Thrombolytics
• anticoagulants

Question 5

What is the immediate management of GI bleeds?

Answer 5

1) history / examination (assess co-morbitidities such as cardiac, liver, renal disease)
2) monitor pulse and blood half hourly
3) Bloods : FBC, U&Es, LFTs, Coagulation screen, Blood group and crossmatch.
4) PR for malaena

Question 6

What are the signs of a peripherally shut down patient?

Answer 6

• Cap refill less than 2s

- lowered urine output less than 0.5 mls/kg/h

Question 7

What is the risk assessment done for upper GI bleeds?

Answer 7

1) Rockall score assess risk of re-bleed and mortalityl after Upper GI bleed. (assesses pre-endoscopic factors and post-endoscopic diagnosis)
OR
2) Glasgow Blatchford score (GBS) used to screen whether GI bleed needs admission and intervention.

Question 8

What is your response in a RRAPID station for a patient with an upper GI bleed?

Answer 8

1) Airways - patent? patient speaking in full sentences?
unconscious - head tilt, chin lift?, oro-pharyngeal adjuct?

2) Breathing - Resp rate high, O2 sats low.
- –> ABG
- –> 15L/min high flow oxygen.

3) Circulation - temperature, low BP, Fast pulse —-> 2 wide bore cannulas, take blood for FBC, U&E, coagulation / clotting screen, LFTs, crsoss match 4-6L.
Give 500mls 0.9% NaCla IV bolus.
Insert urinary catheter to monitor urine output.

4) Disability - glucose? GSC <8 is severe. AVPU.
5) Exposure - scars chest and abdo. Do an abdo exam. Do a PR exam.

6) Organise CXR, ECG
Medication : IV bolus Omeprazole 80mg then continous IV at 8mg/h for 3 days.

7) REASSESS
8) arrange urgent endoscopy
9) transfuse blood
10) monitor hourly

Question 9

What are lower GI bleeds causes by?

Answer 9

• colon cancer
• diverticular disease
• ischaemic colitis
• haemorrhoids
• anal fissures

Question 10

What invx are done for lower GI bleeds?

Answer 10

1) protoscopy for anorectal disease e.g. haemorrhoids
2) Flexible colonoscopy e.g. IBD, cancer, ischaemic colitis, diverticulitis, angiodysplasia
3) Angiography to identify vascular abnormality