Acute GI bleed Flashcards

1
Q

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

A

oesophagus, stomach or duodenum

ligament of treitz

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2
Q

What drugs increases risk of upper GI bleed

A

NSAIDs

Aspirin

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3
Q

Causes of upper GI bleed

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

ulcer, oesophagitis, varices, cancer, Mallory Weiss tear

ulcer, gastritis, varices, cancer

ulcer, duodenitis, angiodysplasia

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4
Q

Risk factors of peptic ulcers and gastritis/duodenitis

A

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

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5
Q

4 Causes of oesophagitis

A

Reflux
Hiatus hernia
Alcohol
Biphosphonates

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6
Q

Cause of oesophageal/gastric varices

A

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

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7
Q

What is mallory-weiss tear

A

linear tear at oesophago-gastric junction –> bleeding

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8
Q

3 Signs of upper Gi bleeding

A

Haematemesis
Melaena (black tarry stool)
Elevated urea

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9
Q

Lower GI bleeds are distal to what

A

Duodenum

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10
Q

Colonic causes of lower GI bleeds (6)

A
Diverticular disease
Haemorrhoids
Angiodysplasia
Neoplasia
Ischaemic colitis
IBD
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11
Q

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

A

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

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12
Q

Signs of lower GI bleeding

A

Fresh blood/clots
Magenta stools
Normal urea

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13
Q

Investigation of upper GI bleeding

A

UGIE - only done when stable

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14
Q

Investigations of lower GI bleeding (3)

A

Flexible sigmoidoscopy
Colonoscopy
CT angiography

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15
Q

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

A

FBC, UandEs, LFTs, coagulation screen, blood group

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16
Q

Acute management of GI bleed (5)

A

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

17
Q

Scoring systems used to determine severity of GI bleeds

A

Rockall score

Glasgow-blatchford score

18
Q

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

A

identifies those at risk of adverse events after UPPER GI BLEED

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

19
Q

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

A

> 8

20
Q

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

A

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

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

21
Q

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

A

≥6

22
Q

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

A

Band ligation

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

IV terlipressin - vasoconstrictor

IV broad spectrum antibiotic prophylaxis

23
Q

Complications of acute GI bleed (4)

A

Circulatory shock due to inadequate tissue oxygen delivery

  • tachypnoea
  • tachycardia
  • cool clammy skin
  • confusion