Acute GI Bleeding Flashcards
What is haematemsis?
Vomiting blood
What is melaena?
Jelly like black tarry stools
Where is the bleed suggested in haemetemesis?
Upper GI
Where is the bleed suggested melaena?
Upper GI
Blood has been digested as passing through the gut
What are some oesophageal causes of upper GI bleeding?
Oesophageal varices
Oesophageal malignancy
Ulcers
Mallory Weiss Tar
What are some gastric causes of upper GI bleeding?
Gastric varices (due to portal hypertension)
Gastric malignancies
Dieulafoy
Submucosal arteriolar vessel eroding through the mucosa
Gastric funduse
ULCERS
What are duodenal causes of upper GI bleeding?
Angiodysplasia
Vascular malformation
Ulcers
What is the most common cause of upper GI bleeding?
Ulcers
What are more common duodenal or gastric ulcers?
Duodenal
What is mallory weiss tear?
Tear where the oesophagus meets the stomach
What are risk factors for peptic ulcers?
H.pylori infection
NSAIDS
Alcohol excess
Systemic illness
What is the link between gastric ulcers and gastric carcinoma?
Gastric ulcers can sit over gastric carcinomas
What are oesophageal varices second to?
Secondary to portal hypertension
What is portal hypertension usually due to?
Liver cirrhosis
Why are oesophageal varices so serious?
Can rupturing can cause severe haemorrhage
What are the 2 main symptoms of oesophageal cancer?
Dysphagia
Weight loss history
What are the key HPC questions for the abdomen?
Dyspepsia? Weight loss Collapse Poor urine Melaena Haematemesis
What are the key PMH questions for the abdomen?
History of liver disease?
What are the key D&A questions for the abdomen?
NSAIDS
Steroids
Anti-coagulants
Anti-platelets
What are the key SH questions for the abdomen?
Alcohol
Smoking history
Where is lower GI bleeding classed from?
Bleeding distal to duodenum
What is the typical presentation of a lower GI bleed?
Fresh blood in stools
What are some potential causes for lower GI bleeding?
Diverticular disease Haemorrhoids Vascular malformations Neoplasia Ischamia colitis Radiation enteropathy IBS
What does diagnosis for lower GI bleeding require?
Flexible sigmoidoscopy
or full colonoscopy
What is diverticular disease?
When there is protrusion of the inner mucosal lining through the outer muscular layer
What is diverticulits
Inflammation in diverticular disease
What % of diverticulitis is self limiting?
75%
Who are haemorrhoids more common in?
Younger people
What are haemorrhoids?
Enlarged vascular cushions around the anal canal
What causes ischeamic colitis?
Disruption to the blood supply of the colon
Which part of the bowel is affected in ischaemic bowel disease?
Depends on if the SMA or IMA is affected
What is the appearance of the bowel on colonoscopy in ischamic colitis?
Bruise like appearance
Dusky blue
What are the 2 categories of IBD?
Ulcerative Colitis
Crohn’s Disease
What appearance does IBD give on colonoscopy?
Cobblestone appearance
What are some small bowel causes for GI bleeding?
Meckel’s diverticulum
Small bowel angiodysplasia
Small bowel tumour
Small bowel ulceration
What is the first step to managing a GI bleed?
ABCDE approach
What does A, B, C, D and E stand for?
Airway Breathing Circulation Disability Exposure
When should an endoscopy be performed on a patient experiencing a GI bleed?
Once ABCDE has been covered and the patient is stable
What is shock?
Circulatory collapse resulting in inadequate tissue oxygen delivery leading to global hypoperfusion and tissue hypoxia
In which age group does acute lower GI bleeding more commonly occur?
In the elderly
How many co-morbidities need to be present to double a patients chance of a severe GI bleed?
2
Which drugs increase the risk of a lower GI bleed?
NSAIDS
Aspirin
Which investigations are appropriate for those experiencing acute abdominal pain?
Xray Erect chest and abdominal xray Abdominal US CT scanning Contrast studies
