Acute GI bleed

Question 1

What differentials would you have for a GI bleed?

Answer 1

Vascular causes- aneurysm/ ulcers/ malformations
Infectious causes- H. Pylori ulcer, entamoeba histolytica
Traumatic injury (Diverticular disease)
Autoimmune (IBD)
Metabolic (?)
Iatrogenic (surgery, NSAIDS/ SSRIs)/ Inflammatory (Oesophagitis/ colitis)
Neoplastic (cancers)

Degenerative (atrophy)

Question 2

How do upper GI bleeds present?

Answer 2

• Haematemesis, coffee ground vomiting, melaena
• Chest pain
• Syncope
• SOB
• Anaemia, coagulopathy

Question 3

How do lower GI bleeds present?

Answer 3

• Blood in stool (haematochezia)
• Hypotension/ tachycardia
• Anaemia
• Shock

Question 4

What investigations would you do for a GI bleed?

Answer 4

• Bloods
  i. FBC (anaemia, infection)
  ii. CRP (inflammation)
  iii. U/E (electrolytes and elevated urea)
  iv. Coagulation
• OGD, colonoscopy, ERCP, Flexi sig w/ or w/o biopsy
  i. Microbiology, cytology and clinical chemistry
• Gastric lavage and aspirate
• Stool- faecal calprotectin, culture
• Rockall scoring/ GBS

Question 5

How do you treat a GI bleed?

Answer 5

• IV fluids
• oxygen
• Hb <7 = blood transfusion
• Endoscopic or radiological intervention (clips, thermal, fibrin)
• Surgery (e.g. TIPS)
• PPIs