Acute Gastrointestinal Bleeding

Question 1

Give 6 causes of upper GI bleeding

Answer 1

Peptic ulcer 
Gastritis 
Oesophagitis 
Erosive duodenitis 
Varices 
Portal hypertensive gastropathy 
Malignancy 
Mallory Weiss tear 
Vascular malformation

Question 2

Give 6 causes of lower GI bleeding

Answer 2

Diverticular disease 
Vascular malformations
Haemorrhoids
Neoplasia 
Ischaemic colitis 
Radiation enteropathy 
Inflammatory bowel disease

Question 3

What is the management of an upper GI haemorrhage?

Answer 3

Resuscitation/identification of shock
Blood transfusion/platelets 
Risk stratification 
ITU/HDU admission 
Early upper GI endoscopy if/when stable 
Embolisation or surgery if endoscopic treatment fails 
Broad spectrum antibiotics 
Proton pump inhibitors

Question 4

What is the management of a bleeding peptic ulcer?

Answer 4

Resuscitation 
Endoscopy 
Endotherapy 
Proton pump inhibitors 
Assess H. pylori status 
Discontinue any causative/contributory mechanisms

Question 5

If bleeding cannot be controlled endoscopically, what should be considered?

Answer 5

Angiography and embolisation

Laparotomy and resection

Question 6

What is the management of variceal bleeding?

Answer 6

Oesophageal - band ligation or glue injection 
Gastric and rectal - glue injection 
Intubation 
IV terlipressin 
IV broad spectrum antibiotics 
Correct coagulopathy

Question 7

What are the management options for uncontrolled variceal bleeding?

Answer 7

Sengstaken-Blakemore tube

Transjugular Intrahepatic Portosystemic Shunt (TIPSS) procedure

Question 8

What is the management of lower GI bleeding?

Answer 8

Colonoscopic haemostatic techniques
Angiography and embolisation
Band ligation for haemorrhoids
Surgery

Question 9

What are the colonoscopic haemostatic techniques that can be used to treat lower GI bleeding?

Answer 9

Adrenaline injections
Bipolar coagulation
Endoscopic haemoclipping