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GI PATHOLOGY > Acute GI Bleeding > Flashcards

Acute GI Bleeding Flashcards

1
Q

How is Upper GI bleeding defined?

A

Oesophagus, stomach or duodenum

Proximal to ligament of Treitz

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2
Q

How is Lower GI bleeding defined?

A

Distal to duodenum

Distal to ligament of Treitz

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3
Q

Presentation of Upper GI bleed

A

Haematemesis
Melaena
Elevated Urea
Dyspepsia, reflux symptoms

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4
Q

What is upper GI bleed associated with?

A

NSAID use

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5
Q

How does lower GI bleed present?

A 
Fresh blood/clots
Magenta stools
Normal urea
Painless
Common in advanced age
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6
Q

Urea is raised in what GI bleed? Why?

A

Upper

Digested blood Haem -> Urea

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7
Q

Causes of upper GI bleed

A

Ulcers
-itises
Varices/Malignancy oes/stom
Angiodysplasia

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8
Q

What is angiodysplasia?

A

Small vascular malformation in the GI system

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9
Q

What are the 3 most common causes of upper GI bleeds?

A

Peptic ulcer
Gastritis
Oesophagitis

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10
Q

Which is the most common peptic ulcer?

A

Duodenal

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11
Q

What are the risk factors for peptic ulcers?

A

H. pylori
NSAIDS/aspirin
Excess alcohol
Systemic illness

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12
Q

How do NSAIDS/aspirin cause peptic ulcers?

A

Decreased prostaglandin production
Reduced mucus, bicarb production
Reduced defences

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13
Q

What must be taken into consideration when you find a peptic ulcer?

A

Ulcer may sit over a carcinoma - repeat endoscopy at 8 weeks
Zollinger-Ellison syndrome

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14
Q

What is Zollinger Ellison syndrome?

A

Recurrent poorly healing duodenal ulcers

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15
Q

What are the risk factors for gastritis/duodenitis?

A

Excess alcohol
NSAIDS/Aspirin
H. pylori
Systemic illness

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16
Q

When are gastritis/duodenitis at increased risk of bleed?

A

When patient has

impaired coagulation

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17
Q

What increases the risk of impaired coagulation?

A

Illness
Anticoagulants
Anti-platelets

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18
Q

When is oesophagitis at increased risk of bleeding?

A

When the patient has impaired coagulation

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19
Q

What are the main causes of oesophagitis?

A 
Reflux
Hiatus hernia
Alcohol
Bisphosphonates
Systemic illness
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20
Q

How can Liver cirrhosis cause a left upper quadrant mass?

A

Splenomegaly secondary to portal hypertension

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21
Q

What are varices?

A

Increased portal pressure causing dilated anastamoses

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22
Q

What is a Mallory-Weiss tear?

A

Linear tear at gastro-oesophageal junction

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23
Q

When does a Mallory-Weiss tear commonly occur?

A

Periods of retching/vomiting

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24
Q

What is a Diuelafoy lesion?

A

A submucosal arteriolar vessel eroding through the mucosa

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25
Q

Where does a Diuelafoy most commonly occur?

A

Gastric fundus

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26
Q

Where can angiodysplasia occur?

A

Anywhere in the GI tract

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27
Q

Angiodysplasia is a frequent cause of what?

A

Occult blood

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28
Q

What is occult blood?

A

Blood in the stool which isnt visibly apparent

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29
Q

Angiodysplasia is associated which what?

A

Chronic conditions

Valve replacement

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30
Q

What investigations would you perform on a patient with a Upper GI bleed?

A

UGIE

diagnostic and therapeutic

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31
Q

What are the colonic causes of Lower GI bleed?

A 
Diverticular disease
Haemorrhoids
Angiodysplasia
Neoplasia
Ischaemia
Radiaton enteropathy
IBD
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32
Q

What is essential in diagnosis for Lower GI bleed?

A

Full colonoscopy/flexible sigmoidoscopy

33
Q

What is diverticulosis?

A

Presence of diverticuli

34
Q

What is diverticulitis?

A

Inflammation of diverticuli

35
Q

What are diverticuli?

A

Protrusion of the inner mucosal lining through the outer muscularis

36
Q

What are haemorrhoids?

A

Enlarged muscular cushions around the anal canal

37
Q

When are haemorrhoids painful?

A

If thrombosed or external

38
Q

What are haemorrhoids associated with?

A

Straining
Constipation
Low fibre diet

39
Q

Angiodysplasia is sometimes associated with what?

A

Heart valve abnormalities

40
Q

Bleeding in angiodysplasia is associated with what?

A

Antiplatelets

Anticoagulants

41
Q

Treatment for angiodysplasia

A

Argon phototherapy
Tranexamic acid
Thalidomide

42
Q

What are the main types of colonic neoplasia?

A

Polyps

Carcinoma

43
Q

What is ischaemic colitis?

A

Disruption of blood supply to the colon

44
Q

How does ischaemic colitis present?

A

Crampy abdominal pain

Sudden bleeding

45
Q

What visible changes occur on endoscopy in ischaemic colitis?

A

Dusky blue, swollen mucosa

46
Q

What are the most common complications of ischaemic colitis?

A

Gangrene

Perforation

47
Q

What treatment commonly occurs to cause radiation proctitis?

A

Cervical/prostate cancer radiotherapy

48
Q

How does radiation proctitis present?

A

Crescendo rectal bleeding over months/years

Dependent on blood transfusions due to chronic loss

49
Q

What is the treatment for radiation proctitis?

A

Argon Plasma Coagulation (APC)
Sulcrafate enemas
Hyperbaric oxygen

50
Q

What are the recommended investigations for acute lower GI bleed?

A

Lower GI endoscopy

CT Angiography

51
Q

If a patient presents with acute lower GI bleed, and no colonic cause is found, what must be excluded?

A

Upper GI bleed

Small bowel origin of LGI bleed

52
Q

What are the most common causes of small bowel Lower GI bleed?

A 
Meckel's Diverticulum
SI Angiodysplasia
SI tumour/GIST
SI ulceration
Aortoentero fistulation
53
Q

What does an aortoentero fistulation commonly follow?

A

AAA repair

54
Q

What small bowel investigations would be performed on a patient with acute Lower GI bleed?

A

CT Angiogram
Meckle’s scan
Capsule endoscopy
Double baloon enteroscopy

55
Q

What is Meckel’s diverticulum?

A

Gastric remnant mucosa of the vitelline duct

56
Q

How is Meckel’s diverticulum diagnosed?

A

Nuclear Scintigraphy

57
Q

Where does Meckel’s diverticulum form in the body?

A

2ft from the ileocaecal valve

58
Q

How is acute GI bleed managed?

A

ABCDE
Endoscopy within 24hrs
Reverse/stop contributary meds
Blood products?

59
Q

What is shock?

A

Circulatory collapse resulting in inadequate tissue oxygen delivery leading to global hypoperfusion –> tissue hypoxia

60
Q

How do you recognise haemorrhagic shock?

A 
Tachypnoea
Tachycardia
Anxiety/confusion
Clammy skin
Oliguria
Hypotension
61
Q

How is shock classified?

A

Stages 1-4

62
Q

How is stage 1 shock classified?

A

<15% blood loss
RR<20
HR<100
Normal urine

63
Q

How is stage 2 shock classified?

A 
15-30% blood loss
RR 20-30
HR 100-120
Decreased pulse pressure
Reduced urine output
64
Q

How is stage 3 shock classified?

A 
30-40% blood loss
RR 30-40
HR 120-140
Low BP
Low pulse pressure
Confusion
Very low urine output
65
Q

How is stage 4 shock classified?

A 
>40% blood loss
RR >40
HR >140
Low BP
Low Pulse pressure
Confused/drowsy
No urine output
66
Q

How is risk in Upper GI bleed classified?

A

Rockall score

67
Q

What does the Rockall score classify?

A

Risk of re-bleed

Risk of death

68
Q

How is the need for endoscopy in Upper GI bleed classified?

A 
(Blatchford score)
Urea
Hb
BP
Heart/liver disease
69
Q

What other factors increase the risk to a patient with Lower GI bleed?

A 
Age
Co-morbidity
Inpatients
Shock/frank bleeding
Drugs (NSAIDs, Aspirin)
70
Q

How are bleeds caused by peptic ulcer managed?

A

PPIs
Endoscopy + endotherapy
Angiography with embolization
Laparotomy

71
Q

What is the purpose of endoscopy for UGI bleeding caused by peptic ulcer?

A

Identify risk of further bleed
Look for cancers
Endoscopic therapy

72
Q

What are the endoscopic therapy options for peptic ulcer?

A 
Injection (adrenaline)
Thermal (gold probe)
Mechanical (clip)
Haemospray
Combination therapy
73
Q

If a peptic ulcer cannot be controlled endoscopically, what is the next line of treatment?

A

Angiography + embolisation

Laparotamy

74
Q

What are the management options for upper GI bleeds caused by varices?

A

Endotherapy: Glue injection, band ligation
IV Terlipressin
IV Broad spec. antiB

75
Q

What is the role of IV Terlipressin?

A

Vasoconstrictor of splanchnic blood supply

(reduces blood flow to the

76
Q

What treatment is indicated in varices bleeding, not controlled at UGIE?

A

Sengstaken-Blakemore tube
+
Transjugular intrahepatic porto-systemic shunt

77
Q

What is coffee ground vomit?

A

Brown vomit, not always GI bleed, often systemic illness

78
Q

Magenta stools suggest what?

A

Bleeding from right colon or distal ileum

79
Q

What is haematochezia?

A

Passage of fresh/altered blood PR

Upper GI “fast transit” or lower GI

GI PATHOLOGY (20 decks)

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