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GI > Acute Gastrointestinal Bleeding > Flashcards

Acute Gastrointestinal Bleeding Flashcards

1
Q

What is upper GI bleeding?

Lower GI bleeding?

A

Bleeding from the oesophagus, stomach or duodenum

Lower: distal to duodenum (jejunum/ileum/colon)

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2
Q

What effect does upper GI bleeding have on stool colour?

Lower GI bleeding

A

Upper: malaena (dark sticky faeces, partially digested blood)
Lower: reddish stools

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3
Q

How does upper GI bleeding present?

A

Haematemesis
malaena
Elevated urea (from digestion of blood)
Dyspepsia/reflux/epigastric pain

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4
Q

How does lower GI bleeding present?

A

Bloody stools (reddish)
Normal urea
Typically painless

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5
Q

Causes of upper GI bleeding?

A

Ulcers (in oes, stomach, duod)
Inflammation (“itis of any of the structures)
Malignancy (oes. & gastric)
Angiodysplasia

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6
Q

Are duodenal or gastric ulcers more common?

A

Duodenal

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7
Q

Why does inflammation lead to upper GI bleeding?

A

Bleeds due to impaired coagulation ability

Worse if on anti-coagulant/anti platelet (LMWH, warfarin, clopidogrel)

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8
Q

Common cause of varices that lead to bleeding?

A

Portal hypertension - often liver cirrhosis

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9
Q

Where do most varices occur?

A

Oesophagus - 90%
Gastric - 8%
Rectal and splenic - rare

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10
Q

What is a Mallory-Weiss tear?

A

Tear in the lining at the oesophago-gastric junction, usually following retching/vomiting

Cause of upper GI bleeds

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11
Q

What is a Diuelafoy?

A

Erosion of submucosal artery through the mucosa (often localised in gastric fundus)

Cause of upper GI bleeds

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12
Q

What is angiodysplasia?

A

Malformation of vascular structures - can cause occult bleeding

Occurs anywhere in the GI tract

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13
Q

Colonic causes of acute lower GI bleeding?

A 
Diverticular disease 
Vascular malformations
Malignancy
Ischaemic colitis
Radiation enteropathy/proctitis
IBD
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14
Q

What is diverticular disease?

A

Protrusion of the mucosal lining through the outer muscular layer

Can cause lower GI bleeds

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15
Q

What is a haemorrhoid?

A

Enlarged vascular cushions around the anal canal

Can cause lower GI bleeding - best treatment is surgical

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16
Q

What is ischaemic colitis?

A

Inflammation due to ischaemia in the bowel - presents with abdominal pain and sudden bleeding

17
Q

What is radiation proctitis?

A

Inflammation of the rectum due to previous radiation exposure
Bleeding can occur for months/years - may begin to rely on blood transfusions

18
Q

Causes of small bowel lower GI bleeding?

A 
Meckel's diverticulum
Angiodysplasia
Malignancy
Ulceration
Aortoenteric fistula
19
Q

Investigations for suspected small bowel bleeding?

A

CT angiogram
Meckel’s scan (scintigraphy)
Capsule endoscopy
Double balloon enteroscopy

20
Q

What is Meckel’s diverticulum? Best investigation?

A

Congenital form of diverticular disease in the small bowel (at umbilical cord)

Nuclear Scintigraphy is diagnostic

21
Q

Best management for GI bleeding?

A

DR ABCDE - for C may require blood transfusion & IV fluids

Endoscopy once stable - withold contributory medications (warfarin etc.)

Surgical/angiography interventions as needed

22
Q

What is shock?

A

State of hypoperfusion to the tissues of the body due to circulatory collapse - can occur with GI bleeding

23
Q

Signs of shock?

A 
High resp rate
High pulse rate 
Anxiety/confusion
Cool, clammy skin
Low urine output (oliguria)
Low BP (hypotension)
24
Q

What score is used to predict mortality after upper GI bleeding? What does it measure?

A

Rockall Score

  • is there shock?
  • Tachycardia?
  • Hypotension?
  • Co-morbidities/conditions?
25
Q

What score is used to decide who needs endoscopy after upper GI bleeds? What does it measure?

A

Blatchford score

  • Urea (mmol/L)
  • Haemoglobin
  • Systolic BP
  • Markers for hepatic/cardiac/other disease
26
Q

What is the scoring system for lower GI bleeding?

A

No validated scoring system

For risk stratification consider - age/co-morbidity/shock?/Drugs

27
Q

Management of peptic ulcer derived GI bleeding?

A

PPI’s
H2 antagonists
Endoscopy

Treat underlying condition/stop bleeding by:
- injection (adrenaline - vasocontriction)

28
Q

Management of varicies causing GI bleeds?

A

Band ligation/glue injection - both done endoscopically

IV Terlipressin - vasoconstrictor of splanchnic blood supply

29
Q

If variceal bleeding is uncontrollable at endoscopy, what procedure is performed?

A

Transjugular intrahepatic porto-systemic shunt

GI (46 decks)

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