Acute Gastrointestinal Bleeding Flashcards
What anatomy does upper GI bleeding involve?
Oesophagus
Stomach
Duodenum
Proximal to ligament of treitz
What anatomy does lower GI bleeding involve?
Small bowel
Colon
Distal to ligament of treitz
What is lower GI bleeding usually but not always?
Fresh or altered blood
What is haematemesis?
Vomiting of blood
What is malaena?
Passage of black, tarry, loose stools per rectum Acute upper GI bleeding
What is haematochezia?
Passage of fresh or altered blood per rectum
What are the three most common causes of GI bleeding?
Peptic ulcers (GU/DU)
Gastritis/Erosions
Oesophagitis
What should always be checked first when their is GI bleeding?
H.pylori
What are varices?
Secondary to portal hypertension, usually due to liver cirrhosis, with abnormally dilated collateral vessels and they are commonly oesophageal (90%)
What should be considered if something is spewed up/passed but has been going on for a short while (Not a shock)?
Oesophageal Cancer
OR
Gastric Cancer
What is Mallory Weiss Tear?
Linear tear in the lower oesophagus with recurrent retching and vomiting
What are the six risk factors for upper GI bleed?
Age (>50years) Co-morbities Inpatients Initial presentation with Haematemesis, Melaena, Shock & Collapse Continued bleeding after admission Elevated blood urea
What six examinations should be done for acute GI bleeding?
Pulse BP Respiratory rate Saturations Abdomen Systems
What five investigations should be done for acute GI bleeding?
FBC U+E's LFTs Coagulation Blood group and x match
What are you looking for on examination?
Liver disease (Varices) Cardiac disease (Angiodysplasia) Lymphadenopathy/Hepatomegaly (Malignancy)
What six things can be donein managing acute GI bleeding?
Resuscitation/Identification of shock
Consider blood transfusion Risk stratification
High risk in HDU
Early endoscopy
Embolisation or surgery if endoscopy won’t work
What score can be used to identify whether a patient needs an endoscopy?
Glasgow Blatchford Score
How should H.pylori be treated?
One week course of eradication therapy
AND
A further three weeks ulcer healing treatment should be given
If on Proton Pump Inhibitors what should be withheld?
Oral anticoagulants
Aspirin
NSAIDs acutely
What is the forrest classification of ulcers?
- Actively bleeding ulcer (80%)
(a) Spurting
(b) Oozing - Non-actively bleeding ulcer
(a) Non-bleeding visible vessel
(b) Adherent clot
(c) Ulcer with red or blue dark spots - Ulcer with clean base
How should varices be managed?
Oesophageal - Band ligation or Glue injection
Gastric - Glue injection
Rectal - Glue injection
Where does 95% of lower GI bleeding originate from?
Colon
What are the major causes of lower GI bleeding?
Diverticular disease Vascular malformations Haemorrhoids Neoplasia Ischaemic colitis Radiation enteropathy/proctitis IBD
What is diverticular disease?
Protrusion of the inner mucosal lining through the outer muscular layer forming a pouch
What is colonic angiodysplasia?
Vascular malformation where bleeding is precipitated by anticoagulants/antiplatelets
What is ischaemic colitis?
Disruption in blood supply to colon which presents with crampy abdominal pain and is self-limiting Restricted to a specific area and is dusk blue with a swollen mucosa
What are the two causes of Inflammatory Bowel Disease (IBD)?
Ulcerative Colitis
OR
Crohn’s Disease
What investigation should be done for lower GI bleeding?
CT Angiography Formal angiography Small bowel capsule enteroscopy Double balloon enteroscopy Bloods – FBC, U+E’S, LFTs, Coag & Blood group
What management options are there for lower GI bleeding?
Colonoscopic haemostatic techniques
Angiography and Embolisation
Band ligation for haemorrhoids
Surgery
What are the risk factors for lower GI bleeding?
Age Co-morbidity Inpatients Initial shock Drugs
What are signs of shock? (6)
Tachypnoea Tachycardia Anxiety/Confusion Cool clammy skin Low urine output (Oliguria) Hypotension
