Acute gastro-intestinal bleed Flashcards
What are the risk factors for acute upper GI bleeds?
Alcohol abuse Liver disease NSAID/anticoagulant use GORD Malignancy Severe/prolonged vomiting
What are the causes of acute upper GI bleeds?
Drug abuse - NSAIDs/alcohol Reflux oesophagitis Oesophageal varices Gastric varices Mallory-Weiss syndrome Gastric/duodenal ulcer Gastric carcinoma Haemmorhagic gastropathy and erosions
What are the signs of an acute upper GI bleed?
Haematemasis Melaena Tachycardia Pallor Hypotension Cold peripheries
What are the symptoms of an acute upper GI bleed?
Haematemasis Melaena Abdominal pain Weakness Dizziness LOC Feeling cold
What other conditions might present in a similar way to acute upper GI bleeds?
Abdominal Aortic Aneurysm Acute Gastritis Barrett Esophagus Oesophageal Cancer Oesophageal Varices Oesophagitis Gastric Cancer Gastric Outlet Obstruction Gastric ulcer Gastrinoma Peptic Ulcer Disease
How would you investigate an acute upper GI bleed?
FBC, U+Es, LFTs, coagulation screen, group and save
Urgent endoscopy in shocked patients/liver disease
What would you tell the patient/how would you explain an acute upper GI bleed to them?
Depends on aetiology…
They had a tear/burst blood vessel in their stomach or gullet which has caused them to vomit some of the blood. Their stools are black/tarry because of the blood that has passed through their digestive system. They have been feeling weak/faint/in shock because of the loss of blood. After stopping the bleeding it’s most important to figure out why it happened with endoscopy/blood tests.
How do you think the patient and/or family might be affected by the acute upper GI bleed? Will it affect their ability to work/care for themselves?
Depends on the aetiology.
When caught early and treated promptly the patient should make a full recovery from the bleeding itself, but whether or not it will recur and how likely that is depends on the cause.
The incident itself is likely to be very frightening to the patient and their family.
What questions is the patient likely to have in the case of an acute upper GI bleed?
Why did it happen?
Will it happen again?
Is there anything I can do to stop it from happening again?
Are their any treatments that can stop it from happening again?
What pharmacological treatments are of use in acute upper GI bleeds?
In ulcers - IV omeprazole for 72 hours, direct injection of adrenaline
In shocked patients: blood tx or colloids
What surgical/other treatments may be used for an acute upper GI bleed?
Banding/stenting of varices
Thermal coagulation of ulcers
What are the causes of acute lower GI bleeds?
Diverticular disease Ischaemic colitis (Small bleeds may be caused by haemmorrhoids, anal fissure etc) Neoplasia Angiodysplasia Polyps Ulcers
What are the signs of an acute lower GI bleed?
Maroon stools, with LGIB from the right side of the colon
Bright red blood per rectum with LGIB from the left side of the colon
Melena with cecal bleeding
(if massive may be bright red from all parts of lower GI tract)
Signs of shock (hypotension, tachycardia etc)
Hb <6
If cause by colitis - fever, dehydration, abdo pain etc
What are the risk factors for acute lower GI bleeds?
Age (>65) Infirmity Liver disease Coagulopathy IBD Hx cancer/radiotherapy
What are the symptoms of an acute lower GI bleed?
Abdo pain
Rectal bleeding
Syncope
Perianal pain
What other conditions might present in a similar way to acute lower GI bleeds?
Angiodysplasia of the Colon Anorectal Abscess Colitis Colon Cancer Colonic Polyps Crohn Disease Diverticulitis Endometriosis Inflammatory Bowel Disease Intussusception Meckel Diverticulum Small Intestinal Diverticulosis Ulcerative Colitis Upper Gastrointestinal Bleeding
How would you investigate an acute lower GI bleed?
Bloods: FBC, coagulation profile (prothrombin time etc), ?LFTs, ?INR, U+Es
Fibre optic flexible colonoscopy
Angiography
CT abdo pelvis with contrast
What would you tell the patient/how would you explain an acute lower GI bleed to them?
Something (ischaemic colitis, ulcer, tumour etc) has caused them to bleed from their lower intestine and this blood has come out of their bottom. We need to find the source of the bleeding and stop it as soon as possible, This may involve a small, flexible camera being passed up their back passage.
How do you think the patient and/or family might be affected by the acute lower GI bleed? Will it affect their ability to work/care for themselves?
They would probably be very frightened and possibly (depending on aetiology) be feeling very unwell. Their activities of daily living would be limited by how unwell they feel and/or how much blood loss they are experiencing.
What questions is the patient likely to have in the case of an acute lower GI bleed?
Am I going to die?
Why has this happened?
Is their anything I can do to stop this from happening again?
What pharmacological treatments are of use in acute lower GI bleeds?
Vasoconstrictive agents:
- vasopressin
- epinephrine (also local injection)
- propranolol
What surgical/other treatments may be used for an acute lower GI bleed?
Colonoscopy to localise the bleeding site then: - Bipolar probe coagulation - Clipping Superselective embolisation In extreme circumstances: - segmental bowel resection - subtotal colectomy
