Acute Gastrointestinal Bleeding Flashcards
What defines upper GI bleeding?
Bleeding from oesophagus, stomach or duodenum
Proximal to ligament of Trietz
What defines lower GI bleeding?
Bleeding distal to duodenum
Distal to ligament of Trietz
What are the signs of upper GI bleeding?
Haematemesis Melaena Elevated urea Dyspepsia, reflux, epigastric pain NSAIDs use
What are the signs of lower GI bleeding?
Fresh blood/clots Magenta stools Normal urea Typically painless More common in older people
What are the causes of upper GI bleeding?
Ulcers Inflammation Malignancy Varices Angiodysplasia Mallory-Weiss tear (tear at oesophago-gastric junction after period of retching/vomiting)
What are the risk factors for peptic ulcers?
H. pylori
NSAIDs/Aspirin
Alcohol excess
Systemic illness = stress ulcers
What are the investigations for upper GI bleeding?
Upper GI endoscopy
What are the causes of lower GI bleeding?
Haemorrhoids Diverticular disease Angiodysplasia Carcinoma/polyps Ischaemic colitis Radiation enteropathy/proctitis IBD
What is the treatment for haemorrhoids?
Elective surgical intervention
What is the treatment for angiodysplasia?
Argon phototherapy
Medication (tranexamic acid, thalidomide)
What are the complications of ischaemic colitis?
Gangrene
Perforation
What is the treatment for radiation proctitis?
APC
Sulcrafate enemas
Hyperbaric oxygen
What are the investigations for lower GI bleeding?
Flexible sigmoidoscopy
Colonoscopy
CT angiography
What are the small bowel causes of lower GI bleeding?
Meckel's diverticulum SB angiodysplasia SB tumour/GIST SB ulceration (NSAIDs) Aortoentero fistulation (after AAA repair)
What are the small bowel investigations?
CT angiogram
Meckel’s scan
Capsule endoscopy
Double balloon enteroscopy
What is the management of GI bleeding?
Endoscopy once stable
Withhold/reverse contributory medication
Blood products
CT angiography/radiology/surgical interventions if required
What are the signs of haemorrhagic shock?
High RR Rapid pulse Anxiety/confusion Cool clammy skin Low urine output Low BP
What is the Rockall score used for?
Primarily to predict death but can also be used to predict re-bleeding
How are peptic ulcers managed?
Proton pump inhibitors
Endoscopy with endotherapy
Angiography with embolisation
Laparotomy
What are the endoscopic therapy options for peptic ulcers?
Injection = adrenaline Thermal - contact Mechanical - clip Haemospray Combination therapy (most effective) = adrenaline + thermal/clips
How are varices managed?
Endotherapy Oesophageal - band ligation, glue injection Gastric - glue injection Rectal - glue injection (Ideally intubated for airway protection) IV terlipressin (vasoconstrictor) IV broad spectrum antibiotics Correct coagulopathy
