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Alimentary System: Pathology SA > Acute Gastrointestinal Bleeding: Lower GI Bleeding > Flashcards

Acute Gastrointestinal Bleeding: Lower GI Bleeding Flashcards

1
Q

What is the colonic cause of GI bleeding

A

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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2
Q

What is required for the diagnosis of Colonic Causes

A

Flexible simoidioscopy

Full colonoscopy

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3
Q

What is the pathology of Divericular disease

A

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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4
Q

Define heamarroids

A

enlarged vascular cushions around the anal canal

  • rarely cause serious bleeding
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5
Q

When does Haemorrhoids become painful

A

If thrombosed or external

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6
Q

What causes haemorrhoids

A

straining
Constipation
Low fibre diet

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7
Q

What is the treatment of haemorrhoids

A

Elective surgical intervention

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8
Q

How do you treat angiodysplasia

A

argon phototherapy

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9
Q

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

A

Colonic polyps or carcinoma

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10
Q

What is the severity ofColonic polyps or carcinoma

A

very rare to cause life threatening bleeding

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11
Q

What is the pathology of ischaemic colitis

A

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

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12
Q

What is the presentation of ischaemic colitis

A
  • Crampy abdominal pain

- self limiting

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13
Q

What is the complications of ischaemic colitis

A

Gangrene

Perforation

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14
Q

What is the appearance of ischaemic colitis

A

Dusky blue

Swollen Mucosa

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15
Q

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

A

Previous history of radiotherapy For:
Cervical cancer
Prostate cancer

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16
Q

What is the presentation of radiation proctitis

A

Crescendo bleeding through rectum

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17
Q

What is the treatment for radiation proctitis

A

Blood transfusion of chronic loss

APC
Sulcrafate enemas
Hyperbaric oxygen

18
Q

What is the two forms of inflammatory bowel disease

A

Ulcerative colitis

Crohns disease

19
Q

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

A

Meckel’s diverticulum

Small bowel angiodysplasia

Small bowel tumour/GIST

Small bowel ulceration (NSAID associated)

Aortoentero fistulation – following AAA repair

20
Q

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

A

CT angiogram

Meckel’s scan (Scintigraphy)

Capsule endoscopy

Double balloon enteroscopy

21
Q

What is meckels diverticulum

A

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

= gastric reminant mucosa

22
Q

What is sued for the diagnosis of Mockers Diverticulum

A

Nuclear scintigraphy

23
Q

What is the protocol for a major haemorrhage

A

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

24
Q

When does a blood transfusion occur in GI bleeding

A

Hb <7g/dl

On going active bleeding

25
Q

What are the blood tests taken in major haemorrhage protocol

and what is inserted

A 
FBC
U&amp;E
LFT
Coagulation
Blood group

Catheter is inserted

26
Q

When is required medicine re commended in GI bleeding

A

Once haemostasis is achieved

27
Q

How does cirulcarory shock arise

A

inadequate tissue oxygen delivery leading to global hypoperfusion and tissue hypoxia

28
Q

What is the symptoms of circulatory shock

A 
Tachypnoea 
Tachycardia 
Anxiety/ confusion 
Cool clammy skin 
Oliguria 
Hypotenion
29
Q

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

A

Age

Shock

Co-morbidity

Diagnosis

Major stigmata of recent haemorrhage

30
Q

What is considered to determine if endoscopic intervention is required

A

Blood urea

Haemoglobin

Systolic blood pressure

Heart rate
Other markers:
Hepatic disease
Cardiac failure

Score >6 means 50% risk of needing intervention

31
Q

What does the risk stratification of Lower GI bleeding consider

A

Age - increased in elderly

Co-morbidity

Inpatients

Initial shock +gross rectal bleeding

Drugs - NSAIDS/aspirin

32
Q

What is the management of peptic ulcers

A

Proton pump inhibitors - omeprazole

Endoscopy with endotherapy

Angiography with embolization

Laparotomy

33
Q

What is the two benefits of endoscopic management of peptic ulcers

A

Identify those at high risk of further bleeding

Endoscopic therapy to pathology

34
Q

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

A

Injection
- Adreanline (constricts area)

Thermal
- heat area to damage BV

Mechanical
- Clip

Heamospray
- mineral blend powder

35
Q

What is the most efficient combined endoscopic therapy

A

adrenaline+ thermal or clips

36
Q

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

A

angiography and embolization

laparotomy

37
Q

How does endotherapy manage Upper GI bleeding Varices

A

Endotherapy

Oesophageal

  • band ligation
  • glue injection

Gastric/renal
- glue injection

38
Q

How is airways protected in endotherapy

A

Airways are intubated

39
Q

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

A

IV terlipresson

IV broad spectrum

Correct coagulapathy

Endotherapy

Sengstaken-Blakemore tube

40
Q

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

A

Is vasoconstrictor of splanchnic blood supply

  • therefore reduced blood flow to portal vein
  • reducing portal pressure
41
Q

What is the purpose ofSengstaken-Blakemore tube

and when is it used

A

Transjugular intrahepatic porto-systemic shunt

Used when bleeding by varices is uncontrolled by endoscopy

Alimentary System: Pathology SA (27 decks)

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