Acute GI bleed

Question 1

Upper GI bleeding is from what parts of the GI tract (3) + proximal to what ligament

Answer 1

oesophagus, stomach or duodenum

ligament of treitz

Question 2

What drugs increases risk of upper GI bleed

Answer 2

NSAIDs

Aspirin

Question 3

Causes of upper GI bleed

• oesophagus (5)
• stomach (4)
• duodenum (3)

Answer 3

ulcer, oesophagitis, varices, cancer, Mallory Weiss tear

ulcer, gastritis, varices, cancer

ulcer, duodenitis, angiodysplasia

Question 4

Risk factors of peptic ulcers and gastritis/duodenitis

Answer 4

H. pylori (produces urease –> ammonia produced –> buffers gastric acid –> increased acid production)
NSAIDs/aspirin
Excess alcohol

Question 5

4 Causes of oesophagitis

Answer 5

Reflux
Hiatus hernia
Alcohol
Biphosphonates

Question 6

Cause of oesophageal/gastric varices

Answer 6

usually due to liver cirrhosis –> portal hypertension –> varices

Question 7

What is mallory-weiss tear

Answer 7

linear tear at oesophago-gastric junction –> bleeding

Question 8

3 Signs of upper Gi bleeding

Answer 8

Haematemesis
Melaena (black tarry stool)
Elevated urea

Question 9

Lower GI bleeds are distal to what

Answer 9

Duodenum

Question 10

Colonic causes of lower GI bleeds (6)

Answer 10

Diverticular disease
Haemorrhoids
Angiodysplasia
Neoplasia
Ischaemic colitis
IBD

Question 11

SI causes of lower GI bleeding - less common than colonic causes (4)

Answer 11

Meckel’s diverticulum – remnant of vitelline duct
Small bowel Angiodysplasia
Small bowel tumour
Small bowel ulcer

Question 12

Signs of lower GI bleeding

Answer 12

Fresh blood/clots
Magenta stools
Normal urea

Question 13

Investigation of upper GI bleeding

Answer 13

UGIE - only done when stable

Question 14

Investigations of lower GI bleeding (3)

Answer 14

Flexible sigmoidoscopy
Colonoscopy
CT angiography

Question 15

Initial investigations on acute admission of upper or lower GI bleed (5)

Answer 15

FBC, UandEs, LFTs, coagulation screen, blood group

Question 16

Acute management of GI bleed (5)

Answer 16

ABCDE (airway, breathing, circulation, disability, exposure) resuscitation

IV fluids
Blood transfusion if Hb <7g/dl
Stop/reverse warfarin, antiplatelets, anticoagulants
IV platelets if platelet count <50

Question 17

Scoring systems used to determine severity of GI bleeds

Answer 17

Rockall score

Glasgow-blatchford score

Question 18

What is the rockall score + what does it take into account (5)

Answer 18

identifies those at risk of adverse events after UPPER GI BLEED

Considers age, shock, co-morbidities, diagnosis, clinical features

Question 19

A score of what in the rockall scoring system indicates high risk of mortality

Answer 19

> 8

Question 20

What is the glasgow-blatchford score + what does it take into account (6)

Answer 20

good at identifying low risk UPPER GI BLEEDS that don’t need to be admitted

urea, Hb, BP, hepatic disease, cardiac failure, melaena

Question 21

A score of what in the glasgow-blatchford scoring system indicates need of medical intervention

Answer 21

≥6

Question 22

Acute treatment of oesophageal/gastric/rectal varices (4)

Answer 22

Band ligation

Glue injection - injecting glue solution which solidifies when it touches blood

IV terlipressin - vasoconstrictor

IV broad spectrum antibiotic prophylaxis

Question 23

Complications of acute GI bleed (4)

Answer 23

Circulatory shock due to inadequate tissue oxygen delivery

• tachypnoea
• tachycardia
• cool clammy skin
• confusion