Acute GI bleed Flashcards
1
Q
Which is more common upper or lower
A
Upper
2
Q
What are the causes of upper GI bleeds
A
- Peptic ulceration
- Mucosal inflam (oesophagitis, gastritis, duodenitis)
- oesophageal varcies
- Mallory-Weiss tear
- Gastric carcinoma
- Coagulation disorders (warfarin)
3
Q
What are the causes of lower GI bleed
A
- Upper GI haemorrhage
- Acute GI haemorrhage (= colon + rectum 20%)
- Angiodysplasia + bleeding from diverticulae
- IBD
- Aortic-enteric fistulae
4
Q
What are the risk factors for upper
A
- Age
- Cancer + HF
- Liver disease
- NSAIDs, aspirin, warfarin, iron, alcohol consumption
5
Q
What are the risk factors for lower
A
- Age
- Co-morbidities
- Hameodynamic disturbance
- NSAID or aspirin
6
Q
What is the presentation of upper bleed
A
- Pain (often not in elderly)
- Haematemesis / malaena
- major upper bleeds = fresh PR bleed (???)
- Ab pain, weight loss, anorexia, syncope
7
Q
What is the clinical presentation of lower bleed
A
- ++ vol fresh/plum coloured rectal bleeding
- Bloody diarrhoea - IBD or infective colitis
- Weight loss, anorexia, change in bowel habits
- Postural dizziness (sev haemorrhage)
8
Q
What do you examine for
A
Check ABCDE.
Assess for hypovolaemic shock (pulse and resp. rates, BP, GCS, skin colour/temperature, cap refill).
Look for any available vomit or faeces.
Check for aortic masses, tenderness or surgical scars.
Look for stigmata of liver disease.
Check for faecal occult blood (FOB)
9
Q
What investigations do you do
A
- FBC, clotting screen, U&E, cross-matching, group + save
- ECG, CXR, endoscopy
- Rockall scoring system
10
Q
What is the management
A
- If hypovolaemic they require immediate resus
- Give O2
- Monitor (cardiac, SpO2, BP monitoring
- Two large bore IV cannulae
- Give 1l of 0.9% saline or hartmann’s solution IV stat
- Insert Ng tube
- Insert urinary catheter
- Correct any coagulopathy / discuss w. haematologist –> Vit K/clotting factor/FFP ?
- Consider the need for a central venous line
- Contact the surgical team and ICU
