Acute GI bleeding

Question 1

What bleeding is classed as upper GI?

Answer 1

Oesophagus
Stomach
Duodenum

Question 2

What are the clinical manifestations of upper GI bleeding?

Answer 2

Haemetemesis
Melaena
Elevated urea
Dyspepsia, reflux, epigastric pain
NSAIDs use

Question 3

What are the causes of upper GI bleeding?

Answer 3

Ulcers
Inflammation
Varices
Angiodysplasia
Malignancy
Tear

Question 4

What are the most common ulcers in the GI tract?

Answer 4

Duodenal

Question 5

What are the risk factors for ulcers?

Answer 5

H. pylori
NSAIDs
Alcohol excess
Systemic illness

Question 6

What may gastric ulcers cover?

Answer 6

Gastric carcinoma

Question 7

What is Zollinger-Ellison syndrome and what does it cause?

Answer 7

Gastrin secreting pancreatic tumour

Causes recurrent poorly healing duodenal ulcers

Question 8

When does inflammation tend to bleed?

Answer 8

In context of impaired coagulation e.g. medical conditions, anticoagulants, anti platelets

Question 9

What is oesoophagitis?

Answer 9

Inflammation of oesophagus

Question 10

What are the causes of oesophagi’s?

Answer 10

Reflux
Hiatus hernia
Alcohol
Bisphosphonates
Systemic illness

Question 11

When are you more likely to get significant bleeding from inflammation?

Answer 11

If patient is on anticoagulants or antiplatelets

Question 12

What are varices?

Answer 12

Abnormally dilated tortuous collateral vessels

Question 13

What are varices secondary to?

Answer 13

Portal hypertension and usually cirrhosis

Question 14

What is the main site of varices?

Answer 14

Oesophagus

Question 15

What can cause varices to bleed?

Answer 15

Increased portal pressure

Question 16

What is angiodysplasia?

Answer 16

Vascular malformation

Question 17

Where can angiodysplasia occur?

Answer 17

Anywhere in GI tract

Question 18

Where does lower GI bleeding occur?

Answer 18

Distal to duodenum (ligament of Trietz)

Question 19

What are the clinical manifestations of lower GI bleeding?

Answer 19

Fresh blood/clots
Magenta stools
Normal urea
Typically painless
More common in advanced age

Question 20

What are the colonic causes of lower GI bleeding?

Answer 20

Diverticular disease
Haemorrhoids
Angiodysplasia
Neoplasia
Ischaemic colitis
Radiation enterotherapy/procitis
IBD

Question 21

What is diverticular disease?

Answer 21

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

Question 22

What is diverticulitis?

Answer 22

Inflammation of diverticular pouch

Question 23

What are haemorrhoids?

Answer 23

Enlarged vascular cushions around anal canal

Question 24

What are haemorrhoids associated with?

Answer 24

Straining
Constipation
Low fibre diet

Question 25

When are haemorrhoids painful?

Answer 25

If thromboses or external

Question 26

What causes angiodysplasia in the lower GI tract?

Answer 26

Degeneration

Question 27

What are the features of lower GI angiodysplasia?

Answer 27

Friable, bleeds easily | Associated with valvular abnormalities

Question 28

What is bleeding in angiodysplasia often preceded by?

Answer 28

Use of anticoagulants and antiplatelets

Question 29

What is the treatment of lower GI angiodysplasia?

Answer 29

Argon phototherapy

Question 30

What does ischaemic colitis present with?

Answer 30

Crampy abdo pain Diarrhoea with blood Over 60s

Question 31

Where does ischaemic colitis often affect?

Answer 31

Descending sigmoid colon

Question 32

What does ischaemic colitis affect areas according to?

Answer 32

Associated blood supply

Question 33

What are the complications of Ischaemic colitis?

Answer 33

Gangrene | Perforation

Question 34

What is the appearance of the mucosa in ischaemic colitis?

Answer 34

Dusky blue, almost bruised looking mucosa

Question 35

What does radiation enterotherapy cause?

Answer 35

Cresendo PR bleeding which may cause the patient to be blood transfusion dependent

Question 36

What is the treatment of radiation enteropathy?

Answer 36

APC Sulfcrafate enemas Hyperbaric oxygen

Question 37

What is radiation enteropathy dependent on a history of?

Answer 37

Previous radiotherapy on cervix or prostate

Question 38

What is the presentation of bleeding with IBD?

Answer 38

Slower onset with diarrhoea symptoms

Question 39

What is treatment of bleeding in IBD dependent on?

Answer 39

Extent and severity

Question 40

What are the small intestine causes of lower GI bleeding?

Answer 40

Meckel's diverticulum Small bowel angiodysplasia/tumour/ulceration Aortoentero fistulation

Question 41

What is Meckel's diverticulum?

Answer 41

Gastric remnant mucosa 2 feet from ileocaecal valve

Question 42

What is small bowel ulceration associated with?

Answer 42

NSAIDs

Question 43

What is aortoentero fistulation associated with?

Answer 43

AAA repair

Question 44

What is the major haemorrhage protocol?

Answer 44

``` IV fluids Blood transfusion (Hb <7) Urgent bloods to lab (FBC, U+E, LFT, coagulation) Catheter Risk calculation for placement in HDU Endoscopy once stable ```

Question 45

How is GI bleeding managed?

Answer 45

Blood transfusion if Hb <7 Review medications Consider CT angiography/interventional radiology/surgical intervention

Question 46

How are peptic ulcers treated?

Answer 46

Proton pump inhibitors Endoscopy with end-therapy- injection of adrenaline thermal clip haemospray combination (usually adrenaline + thermal/clip)

Question 47

How is uncontrollable bleeding from a peptic ulcer treated?

Answer 47

Angiography with embolisation | Laparotomy

Question 48

How are varices treated?

Answer 48

Endotherapy IV terlipression and bro spectrum antibiotics Coagulotherapy Intubate to secure airway

Question 49

How are oesophageal varices treated?

Answer 49

Band ligation | Glue injection

Question 50

How are gastric and rectal varices treated?

Answer 50

Glue injection

Question 51

How in uncontrollable bleeding from varices treated?

Answer 51

Transjugular intrahepatic portosystemic shunt

Question 52

What is shock?

Answer 52

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

Question 53

What are the clinical features of shock?

Answer 53

``` Tachycardia Tachypnoea Anxiety/confusion Cool, clammy skin Oliguria Hypotension ```

Question 54

What do risk stratification scores in shock do?

Answer 54

Allow for assessment of management/admission etc