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Alimentary System > Acute GI Bleed > Flashcards

Acute GI Bleed Flashcards

1
Q

define an upper gastrointestinal haemorrhage

A

proximal to ligament treitz; stomach, oesophagus, duodenum

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2
Q

define lower GI haemorrhage

A

distal to ligament treitz; jejunum, ileum, colon

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3
Q

define haematemesis

A

vomiting fresh blood

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4
Q

define melaena

A

black tarry faeces with digested blood

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5
Q

what can cause gastritis and duodenitis?

A

> h. pylori
NSAID, aspirin
alcohol
stress / systemic illness

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6
Q

name the five most common causes of acute UGI haemorrhage

A 
> peptic ulcer
> oesophagitis
> gastritis
> erosive duodenitis
> varices
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7
Q

what can cause oesophagitis?

A 
> reflux
> hiatus hernia
> alcohol
> systemic illness
> bisphosphonates
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8
Q

why can cirrhosis lead to varices?

A

it causes portal hypertension

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9
Q

what malignancies can lead to acute UGI haemorrhage?

A

> oesophageal cancer

> gastric cancer

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10
Q

what can cause a Mallory Weiss tear?

A

retching and vomiting

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11
Q

what is the aetiology of LGI haemorrhage?

A 
> diverticular disease
> vascular malformations
> ischaemic colitis
> haemorrhoids
> IBD
> neoplasia
> radiation
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12
Q

what is diverticular disease?

A

protrusion of the inner mucosal lining through the outer muscular layer forming a pouch with symptoms

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13
Q

what is the aim of assessment of GI haemorrhage?

A

> identify the sick patient with life threatening hemodynamic compromise then initiating appropriate resuscitation
identify the low risk patients the discharging them or carrying out an outpatient investigation

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14
Q

what may be in the presenting complaint of GI haemorrhage?

A 
> vomiting blood
> black stools
> dyspepsia
> dizzy, collapse
> weight loss
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15
Q

what may be in the past medical history of GI haemorrhage?

A

> chronic liver disease
chronic cardiac, renal disease
malignancy
previous GI haemorrhage

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16
Q

what may be seen in the drug history in a GI haemorrhage?

A

> antiplatelets
NSAID
over the counter medication

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17
Q

when might an UGI haemorrhage present with fresh blood being passed in stool?

A

if there is rapid transit

18
Q

what initial investigations should you carry out in GI haemorrhage?

A

> blood tests
blood gas
12 lead ECG

19
Q

what blood tests do you carry out in the initial investigations of GI haemorrhage?

A

> FBC
U and E’s
coagulation
cross match

20
Q

what scoring system is used in Aberdeen?

A

the Glasgow-Blatchford score

21
Q

how is a Glasgow-Blatchford score of 0/1 managed?

A

consider outpatient investigation or discharge

22
Q

how is a Glasgow-Blatchford score of 2 managed?

A

inpatient investigation

23
Q

What percentage of patients with a score >6 are at greater risk of needing intervention?

A

50%

24
Q

what patients are taken to the bleeding unit/HDU?

A

the haemodynamically compromised

25
Q

what are the targets for resuscitation?

A

> alert
urine output
Hb 80

26
Q

what fluid is used in resuscitation?

A

> crystalloid

> blood products

27
Q

define shock

A

circulatory insufficiency resulting in inadequate oxygen delivery, global hypoperfusion and tissue hypoxia

28
Q

what are the signs/symptoms of shock?

A 
> tachypnoea
> tachycardia
> hypotension
> oliguria
> anxiety/confusion
> cold, clammy skin
29
Q

describe non-endoscopic management

A

> nil by mouth
stop harmful medication (antiplatelets, anticoagulation, NSAID, antihypertensive)
reversal of harmful medication
correct coagulopathy

30
Q

what is the effect of early endoscopy on high risk groups?

A

> reduced transfusion
reduced length of stay
reduced re-bleed
reduced surgical therapy

31
Q

what endoscopic therapies are there for peptic ulcers?

A 
> Injection (adrenaline)
> Thermal (gold probe)
> Mechanical (clip)
> Haemospray
Combination therapy is most effective (adrenaline + thermal/clips)
32
Q

why should you carry out a PPI infusion post endoscopic procedure?

A

> stabilises clot
increases gastric pH
reduces re-bleed

33
Q

in what circumstances should there be a high degree of suspicion of variceal haemorrhage?

A

> signs of chronic liver disease
history of known liver disease
known varices

34
Q

what sort of complications cause patient death in variceal haemorrhage?

A

> sepsis
renal failure
encephalopathy

35
Q

what is the management in variceal haemorrhage?

A 
> GCS reduction
> resuscitation (avoid saline in cirrhosis)
> blood products
> senior support
> gastroenterology
36
Q

what non endoscopic management is there for variceal haemorrhage?

A

> terlipressin
antibiotics
sengstaken-blakemore tube

37
Q

what endoscopic management is there for variceal haemorrhage?

A

> band ligation
glue injection
transjugular intrahepatic portosystemic shunt

38
Q

what are the risk factors for the outcome of LGI haemorrhage?

A 
> age
> co-morbidity
> inpatients (higher mortality rate)
> initial shock
> medication (aspirin and NSAIDs increase risk of LGI bleeding)
39
Q

what surgical management is there for LGI haemorrhage?

A

> subtotal colectomy

> segmental resection

40
Q

what imaging investigations should be carried out in LGI haemorrhage?

A

> flexible sigmoidoscopy or full colonoscopy
If no colonic cause found and UGI bleed excluded, consider small bowel origin so
CT angiogram
Meckel’s scan (scintigraphy)
Capsule endoscopy
Double balloon enteroscopy

41
Q

What is the Glasgow-Blatchford score based on?

A 
> Blood urea
> Haemoglobin
> Systolic blood pressure
> Pulse >100
> Presentation with melaena
> Presentation with syncope
> Hepatic disease
> Cardiac failure

Alimentary System (33 decks)

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