Acute GI bleeding

Question 1

what is the cut off between upper and GI bleeding?

Answer 1

the ligament of Treitz

Question 2

What are the features of upper GI bleeding?

Answer 2

haematemesis
melaena
elevated urea
associated with dyspepsia, reflux and epigastric pain

Question 3

what are the features of lower GI bleeding?

Answer 3

magenta stools
fresh blood/clots
normal urea
typically painless

Question 4

is upper or lower GI bleeding more common in the elderly?

Answer 4

lower GI bleeding

Question 5

why does urea increase with upper GI bleeding?

Answer 5

from digested haemoglobin

Question 6

what are the oesophageal causes of upper GI bleeding?

Answer 6

oesophageal ulcer
oesophagitis 
oesophageal varices 
oesophageal malignancy 
mallory weiss tear

Question 7

what are the stomach causes of upper GI bleed?

Answer 7

gastric ulcer
gastritis 
gastric cancer 
gastric varices
portal hypertensive gastropathy 
diulafoy 
angiodysplasia

Question 8

what are the duodenal cases of an upper GI bleed?

Answer 8

duodenal ulcer
duodenitis
angioplasia

Question 9

what are the causes of lower GI bleed?

Answer 9

diverticular disease 
haemorrhoids
angiodysplasia 
neoplasia (carcinoma or polyps)
ischaemic colitis 
radiation enteropathy/proctits 
inflammatory bowel disease 
small bowel causes

Question 10

what are the small bowel causes of lower GI bleeding?

Answer 10

small bowel angiodysplasia
small bowel tumour / GIST
merkels diverticulum
small bowel ulceration
aortoentero fistula

Question 11

what is the main investigation for upper GI bleeds?

Answer 11

endoscopy

Question 12

what are the investigations for lower GI bleeds?

Answer 12

endoscopy 
CT angiography 
small bowel investigations:
CT angiography
merkels scan (scintigraphy)
capsule enterography 
double balloon enteroscopy

Question 13

what are haemorrhoids?

Answer 13

large vascular cushions around the anal canal

Question 14

what is the treatment for someone with radiation proctitis?

Answer 14

Argon plasma coagulation (APC), sulcrafate enemas, hyperbaric oxygen

Question 15

when is a blood transfusion given in acute bleeding?

Answer 15

if Hb < 7g/dl

Question 16

what is the name of the risk stratification for upper GI bleeding?

Answer 16

rockhall score

Question 17

describe the management of GI bleeding caused by peptic ulcers.

Answer 17

PPI's
endoscopy with endotherapy;
- thermal contact with probe
- adrenaline injection
- mechanical clip
- haemospray
angiography with embolisation
laparotomy

Question 18

describe the management of GI bleeding caused by varies.

Answer 18

endotherapy
- oesophageal band or glue injection
- gastric glue injection
- rectal glue injection
IV terlipressin 
IV antibiotics
correct coagulopathy 
sengstaken-blakemore tube
transjugular intrahepatic portosystemic shunt

Question 19

how does IV terlipressin work and what is it used for?

Answer 19

IV terlipressin is used for treatment of varices causing GI bleeding.
its a vasoconstrictor of splanchnic blood supply which reduces portal pressure

Question 20

what scoring system is used for classifying severity of upper GI bleed?

Answer 20

rockhall score

Question 21

if the cause of the GI bleed is a mallory weiss tear, what rockfall score will it be?

Answer 21

1

Question 22

if the cause of the GI bleed is a malignant tumour, what tockhalv score will it have?

Answer 22

3

Question 23

if the cause of the GI bleed is a duodenal ulcer, what rockfall score will it have?

Answer 23

2