Acute Gastrointestinal Bleeding Flashcards
What is the incidence of GI bleed in the UK?
180/100000
What is the overall mortality of acute GI bleed?
10%
What mainly affects the outcomes of GI bleed?
Identification and promp management
Where can upper GI bleeding occur from?
Oesophagus
Stomach
Duodenum
anywhere proximal to ligament of Trietz
Where can lower GI bleeding occur from?
Bleeding distal to duodenum (jejunum, ileum, colon)
Distal to ligament of Trietz
What is the clinical presentation of upper GI bleed?
Haematemesis
Melaena
Elevated urea (digested blood turns haem into urea)
Dyspepsia, reflux, epigastric pain
What is the clinical presentation of lower GI bleeding?
Fresh blood/clots
Magenta stools
Normal urea (rarely elevated if proximal small bowel origin)
Typically painless
What can cause upper GI bleeds in the oesophagus?
Oesophageal ulcer
Oesophagitis
Oesophageal varices
Mallory Weiss Tear
Oesophageal malignancy
What can cause upper GI bleeds in the stomach?
Gastric ulcer
Gastritis
Gastric varices
Portal hypertensive gastropathy
Gastric malignancy
Dieulafoy
Angiodysplasia
Are duodenal ulcers or gastric ulcers more common?
Duodenal ulcers (75%)
What are risk factors for peptic ulcers?
Helicobacter pylori
NSAIDs/aspirin
Alcohol excess
Systemic illness (stress ulcers)
How does helicobacter pylori lead to gastric ulcers?
Produces urease -> amonia produced -> buffers gastric acid locally -> increased acid production
How does NSAIDs lead to gastric ulcers?
Prostaglandin production -> reduces mucus and bicarbonate excretion -> reduces physical defences
Why when a gastric ulcer is present is a repeat endoscopy indicated at 8 weeks?
They may have been sitting over a gastric carcinoma
What is Zollinger-Ellison syndrome also known as?
Gastrin-secreting pancreatic tumour
How does Zollinger-Ellison syndrome impact duodenal ulcers?
Causes poor healing of duodenal ulcers
What are the risk factors for gastritis and duodenitis similar to?
Risk factors for gastric and duodenal ulcer
What tends to cause gastritis and duodenitis to bleed?
Medical conditions
Anti-coagulants
Anti-platelets
What are examples of anti-coagulants?
Warfarin
Rivaroxaban
Apixaban
Dabigatran
LMWH
What are examples of anti-platelets?
Clipidogrel
Ticagrelor
What are risk factors for oesophagitis?
Reflux oesophagitis
Hiatus hernia
Alcohol
Biphosphonates
Systemic illness
When is oesophagitis most likely to have significant bleeding?
When on anti-platelets or anti-coagulatns
What are varices secondary to?
Portal hypertension, usually due to liver cirrhosis
What are varices?
Abnormally dilated collateral vessels
What are different types of varices?
Oesophageal (90%)
Gastric (8%)
Rectal and splenic (rare)
What are examples of upper GI malignancies?
Oesophageal cancer
Gastric cancer
What is a Mallory-Weiss tear?
Linear tear at oesophageal-gastric junction
What does a Mallory-Weiss tear follow a period of?
Vomiting and retching
What is Diuelafoy?
Submucosal arteriolar vessel eroding through mucosa
Where does Diuelafoy commonly occur?
Gastric fundus
What is an angiodysplasia?
Vascular malformation
Where can an angiodysplasia occur?
Anywhere along the GI tract
What chronic conditions is angiodysplasia associated with?
Heart valve replacement
What investigation is done for upper GI bleeding?
Upper endoscopy
When should an endoscopy be done for an upper GI bleed?
Within 24 hours, sooner if unstable
What are some colonic causes of lower GI bleeding?
Diverticular disease
Haemorrhoids
Vascular malformation (angiodysplasia)
Neoplasia (carcinoma or polyps)
Ischaemic colitis
Radiation enteropathy/proctitis
IBD (such as ulcerative colitis or Crohn’s disease)
What does diagnosis of a lower GI bleed require?
Flexible sigmoidoscopy or full colonoscopy
What is diverticular disease?
Protrusion of the inner mucosal lining through the outer muscular layer forming a pouch
What does diverticulosis mean?
Presence
What does diverticulitis mean?
Inflammation