Acute GI bleeding Flashcards

1
Q

What structure separates the lower and upper GI tract?

A

ligament of trietz - between duodenum and jejunum

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2
Q

What are some symptoms which point more to being an upper GI problem?

A

haematemesis and melaena
elevated urea due to partially digested blood
dyspepsia, reflux, epigastric pain
NSAID use eg ibuprofen

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3
Q

What are some symptoms which point more to being a lower GI problem?

A
fresh blood per rectum 
magenta stools 
painless
older patients
normal urea
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4
Q

Name as many causes of upper GI bleeding as you can

A

ulcers and inflammation
oesophagus - varices, GORD, Mallory Weiss tear, malignancy
stomach - diuelafoy, angiodysplasia - also in duodenum

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5
Q

What are some causes of oesophagitis?

A
bisphosphonates use 
reflux 
osteoporosis
hiatus hernia 
alcohol
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6
Q

What causes oesophageal varices?

A

portal hypertension due to liver failure

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7
Q

How may oesophageal and gastric cancer present differently?

A

gastric - as an ulcer

oesophageal - dysphagia, reflux, ooze

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8
Q

What is a Mallory Weiss tear and how is it treated?

A

tear at gastro-oesophageal junction after a period of retching and vomiting and requires endoscopic treatment

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9
Q

What are diuelafoy?

A

abnormal blood vessel usually found in the gastric fundus which erode from the submucosa to mucosa and bleed

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10
Q

What is angiodysplasia?

A

abnormal vascular formation in the GI tract linked to heart valve replacement which cause chronic bleeding

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11
Q

Describe briefly some important findings on a history taking for peptic ulcer

A

HPC: dyspepsia, weight loss, collapse, poor urine output, melaena/haematemesis
PMH: liver disease, co-morbidities
DH: NSAIDS, steroids, anticoagulants, antiplatelets
SH: alcohol, smoking
FH: H pylori, peptic ulcers

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12
Q

What are the main risk factors for peptic ulcers and why?

A

H pylori -> urease -> ammonia -> buffers gastric acid -> increase acid production
alcohol excess
NSAIDS/aspirin -> prostaglandin reduces mucus and defences
systemic illness -> stress ulcer

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13
Q

Why must endoscopy be repeated in 8 weeks for a gastric ulcer?

A

may sit over a gastric carcinoma

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14
Q

What is zollinger-ellison syndrome and what investigation must be carried out if this is suspected?

A

pancreatic tumour secreting gastrin causing recurrent bleeding of gastric ulcers
look at pancreas for tumours

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15
Q

When do gastritis and duodenitis tend to bleed?

A

impaired coagulation eg medical condiions, medication eg antiplatelets, anticoagulants

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16
Q

List some colonic causes of lower GI bleeding

A

neoplasia - cancer, polyps

diverticular disease, IBD, ischaemic colitis, radiation proctitis, haemorrhoids, vascular malformation

17
Q

How are lower GI bleeding causes diagnosed?

A

flexible sigmoidoscopy or full colonoscopy

18
Q

What is diverticular disease?

A

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

19
Q

What is diverticulosis and diverticulitis?

A

presence

inflammation

20
Q

How is diverticular disease treated?

A

usually self limiting

21
Q

What are haemorrhoids and what 2 reasons will they be painful?

A

enlarged vascular cushions around the anal canal

thrombosed or external

22
Q

What are haemorrhoids associated with?

A

low fibre diet, straining and constipation

23
Q

What is ischaemic colitis and how does it present?

A

disruption in blood supply to the colon
blue swollen mucosa, gangrene, perforation
in over 60s, self limiting and crampy abdominal pain

24
Q

What is radiation colitis related to?

A

radiotherapy for prostate and cervical cancer

25
What are some small bowel causes of GI bleeding?
meckels diverticulum, small bowel tumour, angiodysplasia, ulcer, aortoentero fistula on AAA repair
26
What is meckels diverticulum?
gastric mucosa remnant present in 2% population found 2ft from ileocaecal valve and 2 inches long
27
How is Meckels diverticulum diagnosed?
scinitgraphy
28
Name 4 investigations used for the small bowel
meckels scan - scintigraphy CT angiogram capsule endoscopy and double balloon enteroscopy with biopsy
29
What is the management of GI severe bleeding?
ABCDE approach IV fluids, blood transfusion hb <7g/dl, blood samples, catheter once stable endoscopy, medication etc
30
What is shock?
circulatory collapse resulting in inadequate tissue oxygen delivery leading to global hypoperfusion and tissue hypoxia
31
What are symptoms of the haemorrhagic subtype of shock?
tachypnoea, tachycardia, cold clammy skin, confusion, low blood pressure, low urine output
32
What are the 2 scores used for upper GI bleeding?
Rockall - death/rebleeding | Blatchford - endoscopy, who needed it
33
What is taken into account for lower GI bleeding as there are no definite scoring systems
age, co-morbidities, inpatient, initial shock, drugs
34
Name the 4 managements of peptic ulcers
PPI, endoscopy with endotherapy, laparotomy, angiography with embolization
35
Why are endoscopies and endotherapies used in GI bleeding and what endotherapies are possible?
to identify risk of bleeding | thermal, injection, mechanical clip
36
When are laparotomy and angiography with embolization used in peptic ulcer management?
when bleeding is uncontrollable with endoscopy
37
What endotherapy can be used on varices
oesophageal - band ligation | Oesophageal, gastric, rectal - glue injection
38
Other treatment for varices
IV vasoconstrictor, broad spectrum antibiotics, correct coagulopathy