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acute gastrointestinal bleeding Flashcards

1
Q

Define upper GI bleeding

A

Bleeding from the oesophagus, stomach or duodenum - proximal to the ampulla of vater

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2
Q

Lower GI bleeding

A

Bleeding distal to the duodenum - jejunum, ileum and colon

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3
Q

Describe haematemesis

A

Vomiting of blood

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4
Q

Describe malaena

A

Blood in stool - darker if it is an upper GI bleed and more purple and brighter in lower GI bleed

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5
Q

What is upper GI bleed associated with

A

dyspepsia
reflux
epigastric pain
Painless

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6
Q

What is the urea levels in upper and lower GI bleeds

A

Upper GI - raised urea - partially digested blood broken down to haem which is then excreted as urea

Lower GI - normal urea

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7
Q

What are the causes of upper GI bleeds

A

Oesophageal ulcer
oesophagitis

Gastric ulcer
Gastritis

Duodenal ulcer
Duodenitis

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8
Q

What is the most common cause of an acute upper GI bleed

A

Duodenal ulcer

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9
Q

How does a peptic ulcer occur

A

The protective mucus layer becomes damages and then the acid in the area begins to damage the underlying layer which causes ulceration

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10
Q

What are the risk factors for peptic ulcer

A

H pylori
NSAIDS
aspirin

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11
Q

Describe how H pylori causes a peptic ulcer

A

H. pyloripenetrate the mucus layer of host stomach and adhere the surface of gastric mucosal epithelial cells.
produce ammonia from urea by the urease, and the ammonia netralize the gastric acid to escape from elimination.
prolifirate, migrate, and finally form the infectious focus.
The gastric ulcerization is developed by destruction of mucosa, inflammation and mucosal cell death.

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12
Q

How do NSAIDs cause peptic ulcers

A

They reduce the inflammatory responsw which reduces mucus production

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13
Q

What is Zollinger-Ellison syndrome

A

Gastrin-secreting pancreatic tumour which causes recurrent poor healing duodenal ulcers

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14
Q

What increases risk of upper GI bleeding

A

GORD - can lead to Barret’s oesophagus
Hiatus hernia
Alcohol
Bisphosphonates - bone protection meds which have oesophageal side effects

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15
Q

What are varices

A

Abnormally dilated collateral vessels, secondary to portal hypertension due to liver cirrhosis

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16
Q

What is a Mallory-Weiss tear

A

Linear tear at oesophago-gastric junction which follows period of vomiting

17
Q

What is diuelafoy

A

Submucosal arteriolar vessel eroding through the mucosa

18
Q

What are the colonic causes of lower GI bleeding

A

Diverticular disease
Haemorrhoids
vascular malformations
Neoplasia
ischaemic colitis
radiation proctitis
IBD

19
Q

What is diverticular disease

A

Protrusion of the inner mucosal lining through the outer muscular layer forming a pouch

20
Q

What are haemorrhoids

A

Enlarged vascular cushions around the anal canal that are associated with constipation and a low fibre diet

Can present with itchiness and blood on wiping

21
Q

What is ischaemic colitis and how does it present

A

Disruption in the blood supply to the colon which presents with crampy abdominal pain

22
Q

What is shock

A

Circulatory collapse resulting in inadequate tissue oxygen delivery leading to global hypo-perfusion and tissue hypoxia

23
Q

What is the presentation of shock

A

Tachycardia
Tachypnoea
anxiety or confusion
cool clammy skin
oliguria
hypotension

24
Q

Describe the low-risk criteria of glasgow blatchford score

A

urea <6·5 mmol/L
haemoglobin >=130 g/L (men) or >=120 g/L (women)
systolic blood pressure >=110 mm Hg
pulse <100 beats per min
absence of melaena, syncope, cardiac failure, or liver disease

Scores 6 and over associated with >50% need of intervention

25
Q

What are the endoscopic therapy options for a peptic ulcer

A

injection - adrenaline

Thermal - contact - gold prove

Mechanical - clip

Combination therapy of adrenaline + one of the other options is the most efficient

26
Q

How do Proton pump inhibitors help the management of bleeding in a peptic ulcer

A

they reduce the acidity in the environment which promotes healing

27
Q

What is the management of hepatic varices

A

endoscopy with endotherapy
e.g band ligation where the rubber band over the blood vessel causes it to necrose away

Terlipressin - vasoconstrictor which reduces blood flow to the portal vein

Antibiotics

Sengstaken-Blakemore tube

TIPSS

28
Q

What is a sengstaken-Blakemore tube

A

Using ballooning which causes ballon tamponade - temporary measure which buys time to do TIPSS which is more permanent

29
Q

What is TIPSS

A

Putting a shunt between the portal circulation and systemic circulation to bypass the liver

GI (30 decks)

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