Acute GI Bleed

Question 1

What’s more common, upper or lower GI bleed?

Answer 1

Upper - 75% of GI bleeds are upper in origin

Question 2

What mnemonic is used for causes of upper GI bleed?

Answer 2

GUM BLEEDING
G - gastritis
U - ulcers
M - mallory weiss tear

B - biliary in cause
L - large varices
E - esophagitis
E - entero aortic fistula 
D - duodenitis
I - ischaemia
N - neoplasms
G - gastric erosion

Question 3

What’s the most common cause of upper GI bleed?

Answer 3

Peptic ulcer

Question 4

What are the symptoms of an upper GI bleed?

Answer 4

Haematemesis (vomiting blood)
Coffee ground vomit
Meleana

Question 5

What are the signs of an upper GI bleed?

Answer 5

Tachycardia

Weak pulse

Peripherally shut down so cold, clammy, prolonged cap refill

Tachypnoea

Question 6

What is the Glasgow-Blatchford score used for?

Answer 6

Used in suspected upper GI bleed on initial presentation

Question 7

What is the management approach for upper GI bleed?

Answer 7

ABATED

A - ABCDE approach to resuscitation
B - bloods
A - access (2 cannulas ideally, one for fluids and one for transfusion)
T - transfuse
E - endoscopy 
D - drugs (stop anticoags and NSAIDS)

Question 8

How do you define lower GI bleed?

Answer 8

Bleeding from rectum, anus, or colon

Question 9

What mnemonic is used for causes of lower GI bleed?

Answer 9

DRAIN

D - diverticulosis
R - radiation colitis/proctitis
A - arteriovenous malformation
I - IBD
N - neoplasm

Question 10

How might a lower GI bleed present?

Answer 10

Fresh blood PR

But if chronic ongoing low level blood loss there may be signs of: hypotension, tachycardia, syncope, weakness, confusion, shock