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Systems: Alimentary AB > Acute GI Bleeding > Flashcards

Acute GI Bleeding Flashcards

1
Q

What effects the outcome of acute GI bleeding?

A

Identifications and prompt management

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2
Q

What is considered upper GI bleeding?

A
  • Bleeding from the oesophagus, stomach or duodenum

- Proximal to ligament of Trietz

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3
Q

What is considered lower GI bleeding?

A
  • Bleeding distal to duodenum (jejunum, ileum, colon)

- Distal to ligament Trietz

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4
Q

What can upper GI bleeding present as?

A
  • Haematemesis

- Melaena

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5
Q

Why is urea elevated in upper GI bleeding?

A

Partially digested blood>haem>urea

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6
Q

What is upper GI bleeding associated with?

A
  • Dyspepsia
  • Reflux
  • Epigastric pain
  • NSAID use
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7
Q

What can lower GI bleeding present as?

A
  • Fresh blood/clots
  • Magenta stools
  • Typically painless
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8
Q

When is lower GI bleeding more common?

A

In advanced age

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9
Q

What are the possible sites of upper GI bleeding?

A
  • Oesophagus
  • Stomach
  • Duodenum
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10
Q

Where can ulcers occur?

A

All areas

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11
Q

When do ‘itis’ conditions tend to bleed?

A

Tend to bleed in context of abnormal clotting

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12
Q

What causes of upper GI bleeding can occur in the oesophagus?

A
  • Oesophageal varices
  • Mallory Weiss tear
  • Oesophageal malignancy
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13
Q

What causes of upper GI bleeding can occur in the stomach?

A
  • Gastric varices
  • Gastric malignancy
  • Dieulafoy
  • Angiodysplasia
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14
Q

What cause of upper GI bleeding can occur in the duodenum?

A

Angiodysplasia

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15
Q

What is the most common cause of acute upper GI bleed?

A

Ulcer

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16
Q

What questions are useful in making a diagnosis for upper GI bleeding?

A
  • Are you on any medications?
  • Have you had any abdominal pain?
  • Has there been any change in weight recently?
  • What is your alcohol consumption per week?
  • Do you take any painkillers?
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17
Q

What is the most common GI ulcer?

A

Duodenal

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18
Q

What are the risk factors for peptic ulcers?

A
  • H pylori
  • NSAIDs/aspirin
  • Alcohol excess
  • Systemic illness
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19
Q

Why is H pylori a risk factor for peptic ulcers?

A
  • Urease production
  • Ammonia production
  • Buffers gastric acid
  • Increased acid production
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20
Q

Why are NSAIDs and aspirin risk factors for peptic ulcers?

A
  • Prostoglandin production
  • Reduced mucus and bicarbonate excretion
  • Reduced physical defences
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21
Q

What does Zollinger-Ellison syndrome cause?

A

Recurrent poor healing duodenal ulcers

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22
Q

What may gastric ulcers sit over?

A
  • Gastric carcinoma

- Repeat endoscopy indicated at 8 weeks

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23
Q

What impaired coagulation could lead to bleeding of gastritis and duodenitis?

A
  • Medical conditions
  • Anti-coagulants
  • Anti-platelets
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24
Q

When are you more likely to have significant bleeding with oesophagitis?

A

If on anti-platelets or anti-coagulation

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25
Q

What can cause oesophagitis?

A
  • Reflux
  • Hiatus hernia
  • Alcohol
  • Bisphosphonates
  • Systemic illness
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26
Q

What are varices secondary to?

A

Portal hypertension usually due to liver cirrhosis

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27
Q

Varices

A

Abnormally dilated collateral vessels

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28
Q

What is the incidence of varices within the GIT?

A
  • Oesophageal 90%
  • Gastric 8%
  • Rectal and splenic rare
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29
Q

What can lead to life threatening bleeding with varices?

A

Increases in portal pressure (due to infection, drug us etc)

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30
Q

What is there usually a history of with oesophageal cancer?

A
  • Dysphagia

- Weight loss

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31
Q

What is the typical character of bleeding due to oesophageal cancer?

A

Typically ooze

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32
Q

What other manifestation can gastric cancer present as?

A

Ulcer

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33
Q

What does GU require for healing?

A

Interval endoscopy for healing

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34
Q

What is a Mallory-Weiss tear?

A

Linear tear at oesophageal-gastric junction

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35
Q

What does a Mallory-Weiss tear usually follow?

A

Period of retching/vomiting

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36
Q

What is the outcome of a Mallory Weiss tear?

A

Up to 10% require endoscopic treatment

-Most heal on their own

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37
Q

Diuelafoy

A

Submucosal arteriolar vessel eroding through mucosa

38
Q

Where do diuelafoy occur?

A

Gastric fundus

39
Q

What is angiodysplasia?

A

Vascular malformation

40
Q

Where can angiodysplasia occur?

A

Anywhere in the GIT

41
Q

What is angiodysplasia a frequent cause of?

A

Chronic occult or overt occult bleeding

42
Q

What is angiodysplasia associated with?

A

Chronic conditions including heart valve replacement

43
Q

What are colonic cause of lower GI bleeding?

A
  • Diverticular disease
  • Haemorrhoids
  • Vascular malformations
  • Neoplasia
  • Ischaemic colitis
  • Radiation enteropathy/proctitis
  • Inflammatory bowel disease
44
Q

What does the diagnosis of cause of lower GI bleeding require?

A

Flexible sigmoidoscopy or full colonoscopy

45
Q

Diverticular disease?

A

Protrusion of the inner mucosal lining through the outer muscular layer forming a pouch

46
Q

Diverticulosis

A

Presence of diverticular disease

47
Q

Diverticulitis

A

Inflammation in diverticular disease

48
Q

What is there a risk of with lower GI bleeding due to diverticular disease?

A

Further bleeding

49
Q

What is the prognosis of bleeding due to diverticular disease?

A

Usually self limiting

50
Q

Haemorrhoids

A

Enlarged vascular cushions around anal canal

51
Q

When are haemorrhoids painful?

A

If thrombosed or external

52
Q

What are haemorrhoids associated with?

A

Straining/constipation/low fibre diet

53
Q

What is the treatment for haemorrhoids?

A

Elective surgical intervention

54
Q

What may angiodysplasia be associated with?

A

Valvular abnormalities

55
Q

What is bleeding due to angiodysplasia often precipitated by?

A

Anticoagulants/antiplatelets

56
Q

What is the treatment for angiodysplasia?

A

Argon Phototherapy

57
Q

What is included in colonic neoplasia?

A

Colonic polyps or carcinoma

58
Q

Ischaemic colitis

A

Disruption in bloody supply to colon

59
Q

What does ischaemic colitis affect areas according to?

A

Blood supply

60
Q

What does ischaemic colitis present with?

A

Crampy abdominal pain

61
Q

When is ischaemic colitis more commen?

A

Over 60 years of age

62
Q

What is usually the outcome of bleeding due to ischaemic colitis?

A

Self limiting

63
Q

What complications are associated with ischaemic colitis?

A
  • Gangrene

- Perforation

64
Q

What is the appearance of ischaemic colitis?

A

Dusky blue swollen mucosa

65
Q

What is there a history of in radiation proctitis?

A

Previous history of radiotherapy especially for cervical/prostate cancer

66
Q

What be people with radiation proctitis be dependent on?

A

Blood transfusions due to chronic loss

67
Q

What is the treatment for radiation proctitis?

A
  • APC
  • Sulcrafate enemas
  • Hyperbaric oxygen
68
Q

What is included in the umbrella term IBD?

A
  • UC

- CD

69
Q

What does treatment of IBD depend on?

A

Extent/severity

70
Q

If there is no colonic cause of lower GI bleeding and upper GI bleeding has been excluded what should be considered?

A

Small bowel origin

71
Q

What small bowel origins of bleeding is there?

A
  • Meckels diverticulum
  • Small bowel angiodysplasia
  • Small bowel tumour/GIST
  • Small bowel ulceration (NSAID associated)
  • Aortoentero fistula
72
Q

What small bowel investigations are there for bleeding?

A
  • CT angiogram
  • Meckels scan (scintigraphy)
  • Capsule endoscopy
  • Double balloon enteroscopy
73
Q

What is the diagnostic investigation for Meckel’s diverticulum?

A

Nuclear scintigraphy

74
Q

Meckel’s diverticulum

A

Gastric reminant mucosa

75
Q

What protocol should be followed for GI bleeding?

A

Major haemorrhage protocol

76
Q

What approach should be used for resuscitation for GI bleeding?

A

ABCDE

77
Q

How should circulation be dealt with immediately?

A
  • Wide bored IV access
  • Iv fluids
  • Blood transfusion (if Hb <7g/dl or ongoing bleeding)
  • Urgent bloods
78
Q

Once resuscitated, what else is involved in the management of acute GI bleeding?

A
  • Risk stratification for placement in HDU
  • Endoscopy once stable
  • Withhold/reverse contributory medications
  • Specific medications
  • Consider CT angiography/interventional radiology/surgical interventions as appropriate
79
Q

Shock

A

Circulatory collapse resulting in inadequate tissue oxygen delivery leading to global hypo perfusion and tissue hypoxia

80
Q

What are the signs of haemorrhagic shock?

A
  • Tachypnoea
  • Tachycardia
  • Anxiety or confusion
  • Cool clammy skin
  • Ogliuria
  • Hypotension
81
Q

How can shock be classified?

A

4 stages according to total blood loss

82
Q

What is the Blatchford score used for?

A

Decide who requires endoscopy

83
Q

What does the Rockall score predict?

A

Principally used to predict death but can also be used to predict rebleed

84
Q

What is the link with age and lower GI bleeding?

A

-Often in the elderly

85
Q

What is the link between co-morbidities an lower GI bleeding?

A

Presence of 2 co-morbid conditions doubles the chances of severe bleed

86
Q

What is the management for peptic ulcers?

A
  • Proton pump inhibitor
  • Endoscopy with endotherapy
  • Angiography with embolization
  • Laparotomy
87
Q

What endoscopic therapy options are there for peptic ulcers?

A
  • Injection
  • Thermal
  • Mechanical
  • Haemospray
  • Combination
88
Q

If a peptic ulcer bleeds uncontrollably endoscopically what should be done?

A
  • Angiography and embolization

- Laparotomy

89
Q

What options are there for endotherapy for varices?

A

Endotherapy

  • Oesophageal (band ligation/ glue injection)
  • Gastric (glue injection)
  • Rectal (glue injection)
90
Q

What should the patient ideally be when undergoing endotherapy for varices?

A

Intubated for airway protection

91
Q

What is involved in the management of varices?

A
  • Endotherapy
  • IV terlipressin (vasoconstrictor of splanchnic blood supply)
  • Iv broad spectrum antibiotics
  • Correct coagulopathy
92
Q

What options are there when bleeding is uncontrollable at endoscopy of varices?

A
  • Sengstaken-Blakemore tube

- Transjugular intrahepatic porto-systemic shunt

Systems: Alimentary AB (37 decks)

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