Acute Gastrointestinal Bleeding Flashcards
signs of upper GI bleeding
melaena
haematemesis
elevated urea (digested blood gets converted into urea)
dyspepsia, reflux, epigastric pain
signs of lower GI bleeding
fresh clots/blood
normal urea
typically painless
causes of upper GI bleeding
ulcers (stomach, oesophagus, duodenum)
varices (stomach, oesophagus, duodenum)
malignancy (stomach, oesophagus, duodenum)
gastritis, oesophagitis, duodenitis
most common cause of upper GI bleeding?
peptic ulcer
risk factors for peptic ulcer
H.pylori
NSAIDs/aspirin
alcohol excess
when do gastritis and duodenitis tend to bleed?
in cases of impaired coagulation
causes of oesophagitis
reflux oesophagitis
hiatus hernia
alcohol
biphosphonate
systemic illness
medications that increase bleeds from gastritis and duodenitis?
anti-coagulants
anti-platelets
varices occur secondary to …….. ………..
portal hypertension
most common type of varice (90%)
oesophageal
varices occur secondary to portal hypertension, usually due to …… ……..
liver cirrhosis
mallory wiess tear
tear at the oesophageal - gastric junction
angiodysplasia can cause upper GI bleeding. what is this?
vascular malformation occurring anywhere in the GI tract
how do you investigation upper GI bleeding?
endoscopy
common causes of lower GI bleeding (colonic causes)
diverticular disease
haemorrhoids
angiodysplasia
neoplasia (polyps or carcinoma)
ischaemic colitis
IBD
lower GI bleeding investigations
sigmoidoscopy
colonoscopy
CT angiography
lower GI bleeding - small bowel causes
meckels diverticulum
angiodysplasia
tumour
ulceration (NSAID associated)
fistula
only …. % of lower GI bleeding is from the small bowel
5
steps in management of GI bleed
IV fluids, blood transfusion
urgents samples to lap (FBC, U and Es, LFTs, coagulation)
catheter
endoscopy once stable
shock
circulatory collapse resulting in inadequate tissue oxygen delivery
signs of shock
high resp rate
tachycardia
anxiety/confusion
cool/clammy skin
low BP
management of peptic ulcer
proton pump inhibitors
endoscopy with endotherapy
angiography with embolisation
laparotomy
management of varices
glue injection
IV antibiotics
intubate them!
correct coagulation
magenta stools usually come from bleeding where?
colon (lower GI)
coffee ground vomit is usually the result of what?
systemic illness
not GI bleeding like in this lecture
