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GI System > Acute Gastrointestinal Bleeding > Flashcards

Acute Gastrointestinal Bleeding Flashcards

1
Q

What anatomy does upper GI bleeding involve?

A

Oesophagus
Stomach
Duodenum
Proximal to ligament of treitz

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2
Q

What anatomy does lower GI bleeding involve?

A

Small bowel
Colon
Distal to ligament of treitz

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3
Q

What is lower GI bleeding usually but not always?

A

Fresh or altered blood

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4
Q

What is haematemesis?

A

Vomiting of blood

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5
Q

What is malaena?

A

Passage of black, tarry, loose stools per rectum Acute upper GI bleeding

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6
Q

What is haematochezia?

A

Passage of fresh or altered blood per rectum

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7
Q

What are the three most common causes of GI bleeding?

A

Peptic ulcers (GU/DU)
Gastritis/Erosions
Oesophagitis

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8
Q

What should always be checked first when their is GI bleeding?

A

H.pylori

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9
Q

What are varices?

A

Secondary to portal hypertension, usually due to liver cirrhosis, with abnormally dilated collateral vessels and they are commonly oesophageal (90%)

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10
Q

What should be considered if something is spewed up/passed but has been going on for a short while (Not a shock)?

A

Oesophageal Cancer

OR

Gastric Cancer

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11
Q

What is Mallory Weiss Tear?

A

Linear tear in the lower oesophagus with recurrent retching and vomiting

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12
Q

What are the six risk factors for upper GI bleed?

A 
Age (>50years)
Co-morbities
Inpatients
Initial presentation with Haematemesis, Melaena, Shock & Collapse
Continued bleeding after admission
Elevated blood urea
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13
Q

What six examinations should be done for acute GI bleeding?

A 
Pulse
BP
Respiratory rate
Saturations
Abdomen
Systems
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14
Q

What five investigations should be done for acute GI bleeding?

A 
FBC
U+E's
LFTs
Coagulation
Blood group and x match
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15
Q

What are you looking for on examination?

A 
Liver disease (Varices)
Cardiac disease (Angiodysplasia)
Lymphadenopathy/Hepatomegaly (Malignancy)
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16
Q

What six things can be donein managing acute GI bleeding?

A

Resuscitation/Identification of shock
Consider blood transfusion Risk stratification
High risk in HDU
Early endoscopy
Embolisation or surgery if endoscopy won’t work

17
Q

What score can be used to identify whether a patient needs an endoscopy?

A

Glasgow Blatchford Score

18
Q

How should H.pylori be treated?

A

One week course of eradication therapy

AND

A further three weeks ulcer healing treatment should be given

19
Q

If on Proton Pump Inhibitors what should be withheld?

A

Oral anticoagulants
Aspirin
NSAIDs acutely

20
Q

What is the forrest classification of ulcers?

A
  1. Actively bleeding ulcer (80%)
    (a) Spurting
    (b) Oozing
  2. Non-actively bleeding ulcer
    (a) Non-bleeding visible vessel
    (b) Adherent clot
    (c) Ulcer with red or blue dark spots
  3. Ulcer with clean base
21
Q

How should varices be managed?

A

Oesophageal - Band ligation or Glue injection
Gastric - Glue injection
Rectal - Glue injection

22
Q

Where does 95% of lower GI bleeding originate from?

A

Colon

23
Q

What are the major causes of lower GI bleeding?

A 
Diverticular disease
Vascular malformations
Haemorrhoids
Neoplasia
Ischaemic colitis
Radiation enteropathy/proctitis
IBD
24
Q

What is diverticular disease?

A

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

25
Q

What is colonic angiodysplasia?

A

Vascular malformation where bleeding is precipitated by anticoagulants/antiplatelets

26
Q

What is ischaemic colitis?

A

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

27
Q

What are the two causes of Inflammatory Bowel Disease (IBD)?

A

Ulcerative Colitis

OR

Crohn’s Disease

28
Q

What investigation should be done for lower GI bleeding?

A 
CT Angiography
Formal angiography
Small bowel capsule enteroscopy
Double balloon enteroscopy
Bloods – FBC, U+E’S, LFTs, Coag & Blood group
29
Q

What management options are there for lower GI bleeding?

A

Colonoscopic haemostatic techniques
Angiography and Embolisation
Band ligation for haemorrhoids
Surgery

30
Q

What are the risk factors for lower GI bleeding?

A 
Age 
Co-morbidity
Inpatients
Initial shock
Drugs
31
Q

What are signs of shock? (6)

A 
Tachypnoea
Tachycardia
Anxiety/Confusion
Cool clammy skin
Low urine output (Oliguria)
Hypotension

GI System (38 decks)

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