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GI AM > Acute GI bleeding > Flashcards

Acute GI bleeding Flashcards

1
Q

What bleeding is classed as upper GI?

A

Oesophagus
Stomach
Duodenum

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2
Q

What are the clinical manifestations of upper GI bleeding?

A 
Haemetemesis
Melaena
Elevated urea
Dyspepsia, reflux, epigastric pain
NSAIDs use
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3
Q

What are the causes of upper GI bleeding?

A 
Ulcers
Inflammation
Varices
Angiodysplasia
Malignancy
Tear
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4
Q

What are the most common ulcers in the GI tract?

A

Duodenal

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5
Q

What are the risk factors for ulcers?

A

H. pylori
NSAIDs
Alcohol excess
Systemic illness

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6
Q

What may gastric ulcers cover?

A

Gastric carcinoma

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7
Q

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

A

Gastrin secreting pancreatic tumour

Causes recurrent poorly healing duodenal ulcers

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8
Q

When does inflammation tend to bleed?

A

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

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9
Q

What is oesoophagitis?

A

Inflammation of oesophagus

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10
Q

What are the causes of oesophagi’s?

A 
Reflux
Hiatus hernia
Alcohol
Bisphosphonates
Systemic illness
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11
Q

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

A

If patient is on anticoagulants or antiplatelets

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12
Q

What are varices?

A

Abnormally dilated tortuous collateral vessels

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13
Q

What are varices secondary to?

A

Portal hypertension and usually cirrhosis

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14
Q

What is the main site of varices?

A

Oesophagus

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15
Q

What can cause varices to bleed?

A

Increased portal pressure

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16
Q

What is angiodysplasia?

A

Vascular malformation

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17
Q

Where can angiodysplasia occur?

A

Anywhere in GI tract

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18
Q

Where does lower GI bleeding occur?

A

Distal to duodenum (ligament of Trietz)

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19
Q

What are the clinical manifestations of lower GI bleeding?

A 
Fresh blood/clots
Magenta stools
Normal urea
Typically painless
More common in advanced age
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20
Q

What are the colonic causes of lower GI bleeding?

A 
Diverticular disease
Haemorrhoids
Angiodysplasia
Neoplasia
Ischaemic colitis
Radiation enterotherapy/procitis
IBD
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21
Q

What is diverticular disease?

A

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

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22
Q

What is diverticulitis?

A

Inflammation of diverticular pouch

23
Q

What are haemorrhoids?

A

Enlarged vascular cushions around anal canal

24
Q

What are haemorrhoids associated with?

A

Straining
Constipation
Low fibre diet

25
Q

When are haemorrhoids painful?

A

If thromboses or external

26
Q

What causes angiodysplasia in the lower GI tract?

A

Degeneration

27
Q

What are the features of lower GI angiodysplasia?

A

Friable, bleeds easily

Associated with valvular abnormalities

28
Q

What is bleeding in angiodysplasia often preceded by?

A

Use of anticoagulants and antiplatelets

29
Q

What is the treatment of lower GI angiodysplasia?

A

Argon phototherapy

30
Q

What does ischaemic colitis present with?

A

Crampy abdo pain
Diarrhoea with blood
Over 60s

31
Q

Where does ischaemic colitis often affect?

A

Descending sigmoid colon

32
Q

What does ischaemic colitis affect areas according to?

A

Associated blood supply

33
Q

What are the complications of Ischaemic colitis?

A

Gangrene

Perforation

34
Q

What is the appearance of the mucosa in ischaemic colitis?

A

Dusky blue, almost bruised looking mucosa

35
Q

What does radiation enterotherapy cause?

A

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

36
Q

What is the treatment of radiation enteropathy?

A

APC
Sulfcrafate enemas
Hyperbaric oxygen

37
Q

What is radiation enteropathy dependent on a history of?

A

Previous radiotherapy on cervix or prostate

38
Q

What is the presentation of bleeding with IBD?

A

Slower onset with diarrhoea symptoms

39
Q

What is treatment of bleeding in IBD dependent on?

A

Extent and severity

40
Q

What are the small intestine causes of lower GI bleeding?

A

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

41
Q

What is Meckel’s diverticulum?

A

Gastric remnant mucosa 2 feet from ileocaecal valve

42
Q

What is small bowel ulceration associated with?

A

NSAIDs

43
Q

What is aortoentero fistulation associated with?

A

AAA repair

44
Q

What is the major haemorrhage protocol?

A 
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
45
Q

How is GI bleeding managed?

A

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

46
Q

How are peptic ulcers treated?

A

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

47
Q

How is uncontrollable bleeding from a peptic ulcer treated?

A

Angiography with embolisation

Laparotomy

48
Q

How are varices treated?

A

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

49
Q

How are oesophageal varices treated?

A

Band ligation

Glue injection

50
Q

How are gastric and rectal varices treated?

A

Glue injection

51
Q

How in uncontrollable bleeding from varices treated?

A

Transjugular intrahepatic portosystemic shunt

52
Q

What is shock?

A

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

53
Q

What are the clinical features of shock?

A 
Tachycardia
Tachypnoea
Anxiety/confusion
Cool, clammy skin
Oliguria
Hypotension
54
Q

What do risk stratification scores in shock do?

A

Allow for assessment of management/admission etc

GI AM (34 decks)

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