Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Alimentary System > Acute GI bleeding > Flashcards

Acute GI bleeding Flashcards

1
Q

What is the incidence of GI bleed in the UK?

A

180/100000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the overall mortality of acute GI bleed?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What mainly affects the outcomes of GI bleed?

A

Identification and promp management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where can upper GI bleeding occur from?

A

A
Oesophagus

Stomach

Duodenum

anywhere proximal to ligament of Trietz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where can lower GI bleeding occur from?

A

Bleeding distal to duodenum (jejunum, ileum, colon)

Distal to ligament of Trietz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the clinical presentation of upper GI bleed?

A

Haematemesis

Melaena

Elevated urea (digested blood turns haem into urea)

Dyspepsia, reflux, epigastric pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the clinical presentation of lower GI bleeding?

A

Fresh blood/clots

Magenta stools

Normal urea (rarely elevated if proximal small bowel origin)

Typically painless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the definition of haematemesis?

A

Blood is very emetic/prokinetic, more likely in oesophagus/stomach origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the definition of melaena?

A

Blood is very prokinetic so brisk in significant bleeding, most likely upper GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is upper GI bleeding commonly associated with?

A

Associated with dyspepsia, reflux, epigastric pain
Non-steroidal anti-inflammatory use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

in what age group is lower GI bleeding more common?

A

More common in advanced age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can cause upper GI bleeds in the oesophagus?

A

Oesophageal ulcer

Oesophagitis

Oesophageal varices

Mallory Weiss Tear

Oesophageal malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can cause upper GI bleeds in the stomach?

A

Gastric ulcer

Gastritis

Gastric varices

Portal hypertensive gastropathy

Gastric malignancy

Dieulafoy

Angiodysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Are duodenal ulcers or gastric ulcers more common?

A

Duodenal ulcers (75%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the most common causes of upper GI bleeding?

A

Gastric cancer
Duodenal ulcer
Mallory-Weiss tear
Oesophagitis
Oesophageal varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What questions might you ask in the history for a peptic ulcer?

A

HPC: dyspepsia
(b) Collapse, poor urine output, large volume melaena or haematemesis

PMH: Liver disease

DH: NSAIDs incl over-the-counter, steroids
Anti-coagulants (reversal agents?), anti-platelet agents

SH: Alcohol, smoking, injecting drug use

FH: Peptic ulcers , H pylori

Weight loss raises suspicion of malignancy
NSAIDs (ibuprofen, diclofenac, celecoxib)
FH ulcers may raise suspicion of possible Helicobacter pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are risk factors for peptic ulcers?

A

Helicobacter pylori

NSAIDs/aspirin

Alcohol excess

Systemic illness (stress ulcers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does helicobacter pylori lead to gastric ulcers?

A
  • Penetrate mucus layer and adhere to epithelial cells in gastric mucosa
  • Urease converts urea to ammonia – buffers gastric acid; Protects H. pylori
    -> Duodenal Ulceration
  • proliferation of H. pylori forming an infectious focus
  • Gastric ulcer formation due to:
    Increased acid
    Loss of mucus
    Epithelial cell inflammation and damage
    Inflammatory cell recruitment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does helicobacter pylori lead to gastric ulcers?

A

H. pylori penetrate the mucus layer of host stomach and adhere the surface of gastric mucosal epithelial cells.

produce ammonia from urea by the urease, and the ammonia netralize the gastric acid to escape from elimination.

prolifirate, migrate, and finally form the infectious focus.

The gastric ulcerization is developed by destruction of mucosa, inflammation and mucosal cell death.

Produces urease -> amonia produced -> buffers gastric acid locally -> increased acid production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does NSAIDs lead to gastric ulcers?

A

Prostaglandin production -> reduces mucus and bicarbonate excretion -> reduces physical defences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why when a gastric ulcer is present is a repeat endoscopy indicated at 8 weeks?

A

They may have been sitting over a gastric carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Zollinger-Ellison syndrome also known as?

A

Gastrin-secreting pancreatic tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does Zollinger-Ellison syndrome impact duodenal ulcers?

A

Causes poor healing of duodenal ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the risk factors for gastritis and duodenitis similar to?

A

Similar risk factors to gastric and duodenal ulcer

Tend to bleed in context of impaired coagulation
Medical conditions
Anti-coagulants (warfarin, rivaroxaban, apixaban, dabigatran, LMWH)
Anti-platelets (clopidogrel, ticagrelor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What tends to cause gastritis and duodenitis to bleed?
Medical conditions Anti-coagulants Anti-platelets
26
What are examples of anti-coagulants?
Warfarin Rivaroxaban Apixaban Dabigatran LMWH
27
What are examples of anti-platelets?
Clipidogrel Ticagrelor
28
What are risk factors for oesophagitis?
Hiatus hernia Alcohol Biphosphonates Systemic illness
29
When is oesophagitis most likely to have significant bleeding?
When on anti-platelets or anti-coagulants
30
What are varices secondary to?
Portal hypertension, usually due to liver cirrhosis
31
what are varices?
Abnormally dilated collateral vessels
32
What are different types of varices?
Oesophageal (90%) Gastric (8%) Rectal and splenic (rare)
33
What are examples of upper GI malignancies?
Oesophageal cancer Gastric cancer
34
what can increases in portal pressure (eg infection/drug use) lead to?
Increases in portal pressure (eg infection/drug use) can lead to life threatening bleeding
35
What is a Mallory-Weiss tear?
Linear tear at oesophageal-gastric junction
36
What does a Mallory-Weiss tear follow a period of?
Vomiting and retching
37
oesophageal cancer presentation
May have dysphagia /weight loss history Typically “ooze”
38
gastric cancer presentation
Can present as an ulcer GU needs interval endoscopy for healing
39
Up to 10% of what significant requiring endoscopic treatment?
Mallory-Weiss tear
40
What is Diuelafoy?
Submucosal arteriolar vessel eroding through mucosa
41
Where does Diuelafoy commonly occur?
Gastric fundus
42
What is an angiodysplasia?
Vascular malformation
43
Where can an angiodysplasia occur?
Anywhere along the GI tract
44
What chronic conditions is angiodysplasia associated with?
Heart valve replacement
45
what is angiodysplasia a frequent cause of?
Frequent cause of chronic occult or overt occult bleeding
46
What investigation is done for upper GI bleeding?
upper endoscopy
47
When should an endoscopy be done for an upper GI bleed?
Within 24 hours, sooner if unstable
48
What are some colonic causes of lower GI bleeding?
Diverticular disease Haemorrhoids Vascular malformation (angiodysplasia) Neoplasia (carcinoma or polyps) Ischaemic colitis Radiation enteropathy/proctitis IBD (such as ulcerative colitis or Crohn’s disease)
49
What does diagnosis of a lower GI bleed require?
Flexible sigmoidoscopy or full colonoscopy
50
What is diverticular disease?
Protrusion of the inner mucosal lining through the outer muscular layer forming a pouch
51
what does diagnosis of acute lower GI bleeding require?
Diagnosis requires flexible sigmoidoscopy or full colonoscopy
52
What is diverticular disease?
Protrusion of the inner mucosal lining through the outer muscular layer forming a pouch
53
What does diverticulosis mean?
Presence
54
What does diverticulitis mean?
Inflammation
55
What is the main risk of diverticular disease
Bleeding occurs in 10-20% during the lifetime 10% chance of recurrence at one year and 25% at four years. Risk of further bleeding
56
What are haemorrhoids?
Enlarged vascular cushions around anal canal Painful if thrombosed or external Association with straining/constipation/low fibre diet
57
When are haemorrhoids painful?
if thrombosed or external
58
What are haemorrhoids associated with?
straining/constipation/low fibre diet
59
What is the treatment for haemorrhoids?
elective surgical intervention
60
What is bleeding due to angiodysplasia often precipitated by?
Bleeding often precipitated by anticoagulants/antiplatelets
61
What is the treatment for angiodysplasia?
Argon Phototherapy
62
what is angiodysplasia?
Vascular malformation Degeneration Friable and bleeds easily May be association with valvular abnormalities
63
What are different kinds of colonic neoplasia?
Colonic polyps or carcinoma
64
what is colonic neoplasia often preceded by?
lower GI symptoms Very rare to cause life-threatening bleeding
65
What is ischaemic colitis?
disruption in blood supply to colon Affects areas according to blood supply, typically descending/sigmoid colon
66
What determines what area of the colon ischaemic colitis affects?
Affects areas according to blood supply, typically descending/sigmoid colon
67
68
What does ischaemic colitis typically affect?
typically descending/sigmoid colon
69
What are possible complications of ischaemic colitis?
gangrene and perforation
70
What is usually present in radiation proctitis?
Crescendo PR bleeding May be dependent on blood transfusions due to chronic loss
71
what is the presentation of ischaemic colitis?
crampy abdominal pain Dusky blue, swollen mucosa
72
who does ischaemic colitis most commonly affect?
More common over 60 years
73
What is the treatment for radiation proctitis?
APC Sulcrafate enemas Hyperbaric oxygen
74
what does treatment of IBD depend on?
blood transfusions due to chronic loss
75
what previous history will patients presenting with radiation proctitis have?
previous history of radiotherapy Cervical cancer Prostate cancer
76
describe IBD?
Ulcerative colitis or Crohn’s disease of colon Slower onset with diarrhoea symptoms Treatment depends on extent/severity
77
what are some causes of small bowel bleeding?
Meckel’s diverticulum Small bowel angiodysplasia Small bowel tumour/GIST Small bowel ulceration (NSAID associated) Aortoentero fistulation – following AAA repair
78
When should small bowel origin of bleeding be considered?
If no colonic cause is found and upper GI bleeding excluded need to consider small bowel origin (5%)
79
What percentage of GI bleeds are small bowel?
5%
80
What investigations can be done to look at bleeding in the small bowel?
CT angiogram Meckel’s scan (Scintigraphy) Capsule endoscopy Double balloon enteroscopy
81
What is Meckel’s diverticulum?
an outpouching or bulge in the lower part of the small intestine. The bulge is congenital (present at birth) and is a leftover of the umbilical cord.
82
What is used to diagnose Meckel’s diverticulum?
Nuclear Scintigraphy With acid secretion from gastric tissue, small bowel ulceration can occur leading to bleeding. Scintigraphy uses radioisotope labelling to detect the gastric mucosa.
83
What is gastrointestinal bleeding managed by?
Resuscitation Airway Breathing Circulation Wide bored IV access => IV fluids Urgent blood samples to lab: FBC, UE, LFT, Coagulation, blood group and save/ cross match Blood transfusion if Hb<7g/dl or ongoing active bleeding Catheter Disability Exposure
84
What management in terms of circulation is done for gastrointestinal bleeding?
Wide bored IV access => IV fluids Urgent blood samples to lab: FBC, UE, LFT, Coagulation, blood group and save/ cross match Blood transfusion if Hb<7g/dl or ongoing active bleeding
85
When is a blood transfusion given for gastrointestinal bleeding?
if Hb<7g/dl or ongoing active bleeding
86
what is shock?
Circulatory collapse resulting in inadequate tissue oxygen delivery leading to global hypoperfusion and tissue hypoxia
87
What is the clinical presentation of shock?
a high respiratory rate (tachypnoea) a rapid pulse (tachycardia) anxiety or confusion cool clammy skin low urine output (oliguria) low blood pressure (hypotension)
88
What are the different stages of shock?
stage 1-4
89
describe stage 1 of shock
Volume lost % Blood loss RR HR BP Pulse pressure Conscious level Urine output <750ml <15% <20 <100 Normal Normal Normal/ anxious >30ml/h
90
describe stage 2 of shock
Volume lost % Blood loss RR HR BP Pulse pressure Conscious level Urine output 750-1500ml 15-30% 20-30 100-120 Normal Decreased Agitated 20-30ml/h
91
describe stage 3 of shock
Volume lost % Blood loss RR HR BP Pulse pressure Conscious level Urine output 1500-2000ml 30-40% 30-40 120-140 Low Decreased Confused 5-15ml/h
92
describe stage 4 classification of shock?
Volume lost % Blood loss RR HR BP Pulse pressure Conscious level Urine output >2000ml >40% >40 >140 Low Decreased Confused/ drowsy 0
93
What does the management of GI bleeding involve?
Resuscitation Risk stratification - ? Critical care placement Diagnosis + treatment Upper GI: Endoscopy – once stable, within 24 hours -> therapeutic options Lower GI: ? Colonoscopy or CT angiogram – depending on bleeding severity Withhold/reverse contributory medications as able* Vitamin K +/- beriplex if on warfarin Specific medications PPI Tranexamic acid?? Consider CT angiography/interventional radiology/surgical interventions as appropriate *re-commencing required medications once haemostasis achieved
94
what risk stratification score is used for acute GI bleeding?
Risk Stratification UGIB: Rockall Score
95
what are the components of rockall score?
Age Shock Co-morbidity Diagnosis Major stigmata of recent haemorrhage
96
what would be a score of 0 on the rockall score?
<60 No Shock No major co-morbidity MWT, No lesion identified No SRH None or dark spot only
97
what would be a score of 1 on the rockall score?
60-79 Tachycardia HR>100 BP>100 mm Hg All other diagnoses
98
what would be a score of 2 on the rockall score?
>80 Hypotension HR>100 BP <100mm Hg Cardiac failure, IHD, any major co-morbidity Malignancy of upper GI tract Blood in upper GI tract Adherent clot Visible vessel Spurting vessel
99
what would be a score of 3 on the rockall score?
renal failure, liver failure, disseminated cancer
100
Other than Rockall score, what else can be used to risk stratification of upper GI bleeding?
Blatchford Score
101
What things are considered for the blatchford score?
Pre-endoscopy score: Blood urea (mmol/L) Haemoglobin sex differences (g/L) Systolic blood pressure (mm Hg) Heart rate Other markers Collapse Melaena Hepatic disease Cardiac failure
102
What is low risk criteria for Glasgow blatchford score?
Low-risk criteria of Glasgow Blatchford Score urea <6·5 mmol/L haemoglobin >=130 g/L (men) or >=120 g/L (women) systolic blood pressure >=110 mm Hg pulse <100 beats per min absence of melaena, syncope, cardiac failure, or liver disease
103
What score for the blatchford score is associated with greater than 50% risk of needing an intervention?
Scores ≥6 associated with a greater than 50% risk of needing an intervention
104
wat score on the blatchford score would consider discharge +/- outpatient investigations?
scores <2
105
What scoring system is used for risk stratification of lower GI bleeding?
No validated scoring systems
106
Is the relationship between age and mortality more defined in lower or upper GI bleeding?
more defined in upper GI bleeding
107
What is the relationship between co-morbidity and severe bleed?
Presence of 2 co-morbid conditions doubles the chance of a severe blee
108
How does inpatients who have rectal bleeding impact mortality?
Inpatients who have rectal bleeding have a 23% mortality compared to 3.6%
109
How do drugs impact the risk of lower GI bleeding?
Patients taking Aspirin and NSAIDs are at increased risk of lower GI bleeding, OR 1.8-2.7
110
what are important predictors of subsequent severe bleeding
initial shock and gross rectal bleeding
111
What is the benefit of using dedicated teams to manage acute GI bleeding?
Improved mortality in patients with acute gastrointestinal bleeding who are managed by dedicated teams Improved outcome due to protocolised care, prompt resuscitation and close medical and surgical liaison
112
Why does having dedicated teams improve the outcome of acute GI bleeding?
protocolised care, prompt resuscitation and close medical and surgical liaison
113
What is the management of a peptic ulcer?
Endoscopy Proton pump inhibitors Angiography with embolization Laparotomy
114
What are management options of GI bleeding due to Peptic Ulcer?
Endoscopy Diagnostic Identify those at high risk of further bleeding Endotherapy Proton pump inhibitors Angiography with embolization Laparotomy
115
What are endoscopic therapy to pathology options for the management of a peptic ulcer?
Injection Adrenaline 1:10000 Thermal Contact – “gold probe” Mechanical Clip Combination therapy most effective (adrenaline + thermal or clips)
116
What is the management for a peptic ulcer when bleeding is uncontrollable?
angiography with embolisation laparotomy
117
What are endoscopic therapy to pathology options for the management of a peptic ulcer?
Injection Adrenaline 1:10000 Thermal Contact – “gold probe” Mechanical Clip Combination therapy most effective (adrenaline + thermal or clips)
118
What is the management of varices?
Endoscopy with endotherapy Ideally intubated with airway protected Terlipressin Antibiotics Reverse abnormal coagulation Sengstaken-Blakemore tube TIPSS
119
What are different kinds of endotherapy for oesophageal varices?
Band ligation Glue injection
120
What are different kinds of endotherapy for gastric varices?
Glue injection
121
What are different kinds of endotherapy for rectal varices?
Glue injection
122
What is the management of varices if bleeding uncontrollable endoscopically?
Sengstaken-Blakemore tube TIPSS - Transjugular intrahepatic porto-systemic shunt (TIPSS)
123
Acute Gastrointestinal bleeding
Variety of causes both upper and lower Good clinical history is useful is predicting diagnosis and outcomes Essential to undertake thorough clinical assessment and escalate care as appropriate Endoscopy is both diagnostic and therapeutic in many cases

Alimentary System (44 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions