Acute Gastrointestinal Bleeding

Question 1

signs of upper GI bleeding

Answer 1

melaena

haematemesis

elevated urea (digested blood gets converted into urea)

dyspepsia, reflux, epigastric pain

Question 2

signs of lower GI bleeding

Answer 2

fresh clots/blood

normal urea

typically painless

Question 3

causes of upper GI bleeding

Answer 3

ulcers (stomach, oesophagus, duodenum)

varices (stomach, oesophagus, duodenum)

malignancy (stomach, oesophagus, duodenum)

gastritis, oesophagitis, duodenitis

Question 4

most common cause of upper GI bleeding?

Answer 4

peptic ulcer

Question 5

risk factors for peptic ulcer

Answer 5

H.pylori

NSAIDs/aspirin

alcohol excess

Question 6

when do gastritis and duodenitis tend to bleed?

Answer 6

in cases of impaired coagulation

Question 7

causes of oesophagitis

Answer 7

reflux oesophagitis

hiatus hernia

alcohol

biphosphonate

systemic illness

Question 8

medications that increase bleeds from gastritis and duodenitis?

Answer 8

anti-coagulants

anti-platelets

Question 9

varices occur secondary to …….. ………..

Answer 9

portal hypertension

Question 10

most common type of varice (90%)

Answer 10

oesophageal

Question 11

varices occur secondary to portal hypertension, usually due to …… ……..

Answer 11

liver cirrhosis

Question 12

mallory wiess tear

Answer 12

tear at the oesophageal - gastric junction

Question 13

angiodysplasia can cause upper GI bleeding. what is this?

Answer 13

vascular malformation occurring anywhere in the GI tract

Question 14

how do you investigation upper GI bleeding?

Answer 14

endoscopy

Question 15

common causes of lower GI bleeding (colonic causes)

Answer 15

diverticular disease

haemorrhoids

angiodysplasia

neoplasia (polyps or carcinoma)

ischaemic colitis

IBD

Question 16

lower GI bleeding investigations

Answer 16

sigmoidoscopy

colonoscopy

CT angiography

Question 17

lower GI bleeding - small bowel causes

Answer 17

meckels diverticulum

angiodysplasia

tumour

ulceration (NSAID associated)

fistula

Question 18

only …. % of lower GI bleeding is from the small bowel

Answer 18

5

Question 19

steps in management of GI bleed

Answer 19

IV fluids, blood transfusion

urgents samples to lap (FBC, U and Es, LFTs, coagulation)

catheter

endoscopy once stable

Question 20

shock

Answer 20

circulatory collapse resulting in inadequate tissue oxygen delivery

Question 21

signs of shock

Answer 21

high resp rate

tachycardia

anxiety/confusion

cool/clammy skin

low BP

Question 22

management of peptic ulcer

Answer 22

proton pump inhibitors

endoscopy with endotherapy

angiography with embolisation

laparotomy

Question 23

management of varices

Answer 23

glue injection

IV antibiotics

intubate them!

correct coagulation

Question 24

magenta stools usually come from bleeding where?

Answer 24

colon (lower GI)

Question 25

coffee ground vomit is usually the result of what?

Answer 25

systemic illness

not GI bleeding like in this lecture