enlarged vascular cushions around the anal canal - rarely cause serious bleeding

Acute Gastrointestinal Bleeding: Lower GI Bleeding Flashcards by Sarah Anderson

What is the colonic cause of GI bleeding

Diverticular disease

Haemorrhoids

Vascular malformations (angiodysplasia)

Neoplasia (carcinoma or polyps)

Ischaemic colitis

Radiation enteropathy/proctitis

Inflammatory bowel disease (eg. ulcerative proctitis, Crohn’s disease)

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What is required for the diagnosis of Colonic Causes

Flexible simoidioscopy

Full colonoscopy

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What is the pathology of Divericular disease

Protrusion of the inner mucosal lining through the outer muscular layer forming a pouch

self limiting

increases risk of further bleeding

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Define heamarroids

enlarged vascular cushions around the anal canal

rarely cause serious bleeding

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When does Haemorrhoids become painful

If thrombosed or external

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What causes haemorrhoids

straining
Constipation
Low fibre diet

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What is the treatment of haemorrhoids

Elective surgical intervention

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How do you treat angiodysplasia

argon phototherapy

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What are the two forms of colonic neoplasia that can cause acute lower GI bleed

Colonic polyps or carcinoma

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What is the severity ofColonic polyps or carcinoma

very rare to cause life threatening bleeding

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What is the pathology of ischaemic colitis

Disruption in blood supply to the colon - typically in the descending and sigmoid colon

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What is the presentation of ischaemic colitis

Crampy abdominal pain

- self limiting

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What is the complications of ischaemic colitis

Gangrene

Perforation

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What is the appearance of ischaemic colitis

Dusky blue

Swollen Mucosa

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What is the aetiology of radiation proctitis (inflammation of rectum and anus)

Previous history of radiotherapy For:
Cervical cancer
Prostate cancer

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What is the presentation of radiation proctitis

Crescendo bleeding through rectum

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What is the treatment for radiation proctitis

Blood transfusion of chronic loss

APC
Sulcrafate enemas
Hyperbaric oxygen

What is the two forms of inflammatory bowel disease

Ulcerative colitis

Crohns disease

What is 5 small bowel causes that result in acute lower GI bleed

Meckel’s diverticulum

Small bowel angiodysplasia

Small bowel tumour/GIST

Small bowel ulceration (NSAID associated)

Aortoentero fistulation – following AAA repair

What is the investigations used for small bowel causes of lower GI bleed

CT angiogram

Meckel’s scan (Scintigraphy)

Capsule endoscopy

Double balloon enteroscopy

What is meckels diverticulum

2inches Budge in small intestine caused by an incomplete obliteration of the vitelline duct located 2 ft from ileocaecal

= gastric reminant mucosa

What is sued for the diagnosis of Mockers Diverticulum

Nuclear scintigraphy

What is the protocol for a major haemorrhage

ABCDE Approach

Blood transfusion

Endoscope once stable within 24 hours

Withhold contributory medication
(eg vitamin K if on warfarin)

Consider:
CT angiography
interventional radiology
surgical intervention

When does a blood transfusion occur in GI bleeding

Hb <7g/dl

On going active bleeding

What are the blood tests taken in major haemorrhage protocol and what is inserted

``` FBC U&E LFT Coagulation Blood group ``` Catheter is inserted

When is required medicine re commended in GI bleeding

Once haemostasis is achieved

How does cirulcarory shock arise

inadequate tissue oxygen delivery leading to global hypoperfusion and tissue hypoxia

What is the symptoms of circulatory shock

``` Tachypnoea Tachycardia Anxiety/ confusion Cool clammy skin Oliguria Hypotenion ```

What does risk stratification consider to predict the likelihood of a re-bleeding occurring

Age Shock Co-morbidity Diagnosis Major stigmata of recent haemorrhage

What is considered to determine if endoscopic intervention is required

Blood urea Haemoglobin Systolic blood pressure Heart rate Other markers: Hepatic disease Cardiac failure Score >6 means 50% risk of needing intervention

What does the risk stratification of Lower GI bleeding consider

Age - increased in elderly Co-morbidity Inpatients Initial shock +gross rectal bleeding Drugs - NSAIDS/aspirin

What is the management of peptic ulcers

Proton pump inhibitors - omeprazole Endoscopy with endotherapy Angiography with embolization Laparotomy

What is the two benefits of endoscopic management of peptic ulcers

Identify those at high risk of further bleeding Endoscopic therapy to pathology

What is the 4 forms of endoscopic therapy options for peptic ulcer

Injection - Adreanline (constricts area) Thermal - heat area to damage BV Mechanical - Clip Heamospray - mineral blend powder

What is the most efficient combined endoscopic therapy

adrenaline+ thermal or clips

What are the two procedures used if bleeding cant be controlled endoscopically

angiography and embolization laparotomy

How does endotherapy manage Upper GI bleeding Varices

Endotherapy Oesophageal - band ligation - glue injection Gastric/renal - glue injection

How is airways protected in endotherapy

Airways are intubated

What is the 4 possible managements of Varices causing upper GI bleeding

IV terlipresson IV broad spectrum Correct coagulapathy Endotherapy Sengstaken-Blakemore tube

What is the mechanism of IV terlipressin and how does this manage varices

Is vasoconstrictor of splanchnic blood supply - therefore reduced blood flow to portal vein - reducing portal pressure

What is the purpose ofSengstaken-Blakemore tube | and when is it used

Transjugular intrahepatic porto-systemic shunt Used when bleeding by varices is uncontrolled by endoscopy