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Acute GI Bleeding Flashcards

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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
Where does a Diuelafoy most commonly occur?
Gastric fundus
26
Where can angiodysplasia occur?
Anywhere in the GI tract
27
Angiodysplasia is a frequent cause of what?
Occult blood
28
What is occult blood?
Blood in the stool which isnt visibly apparent
29
Angiodysplasia is associated which what?
Chronic conditions | Valve replacement
30
What investigations would you perform on a patient with a Upper GI bleed?
UGIE | diagnostic and therapeutic
31
What are the colonic causes of Lower GI bleed?
``` Diverticular disease Haemorrhoids Angiodysplasia Neoplasia Ischaemia Radiaton enteropathy IBD ```
32
What is essential in diagnosis for Lower GI bleed?
Full colonoscopy/flexible sigmoidoscopy
33
What is diverticulosis?
Presence of diverticuli
34
What is diverticulitis?
Inflammation of diverticuli
35
What are diverticuli?
Protrusion of the inner mucosal lining through the outer muscularis
36
What are haemorrhoids?
Enlarged muscular cushions around the anal canal
37
When are haemorrhoids painful?
If thrombosed or external
38
What are haemorrhoids associated with?
Straining Constipation Low fibre diet
39
Angiodysplasia is sometimes associated with what?
Heart valve abnormalities
40
Bleeding in angiodysplasia is associated with what?
Antiplatelets | Anticoagulants
41
Treatment for angiodysplasia
Argon phototherapy Tranexamic acid Thalidomide
42
What are the main types of colonic neoplasia?
Polyps | Carcinoma
43
What is ischaemic colitis?
Disruption of blood supply to the colon
44
How does ischaemic colitis present?
Crampy abdominal pain | Sudden bleeding
45
What visible changes occur on endoscopy in ischaemic colitis?
Dusky blue, swollen mucosa
46
What are the most common complications of ischaemic colitis?
Gangrene | Perforation
47
What treatment commonly occurs to cause radiation proctitis?
Cervical/prostate cancer radiotherapy
48
How does radiation proctitis present?
Crescendo rectal bleeding over months/years | Dependent on blood transfusions due to chronic loss
49
What is the treatment for radiation proctitis?
Argon Plasma Coagulation (APC) Sulcrafate enemas Hyperbaric oxygen
50
What are the recommended investigations for acute lower GI bleed?
Lower GI endoscopy | CT Angiography
51
If a patient presents with acute lower GI bleed, and no colonic cause is found, what must be excluded?
Upper GI bleed | Small bowel origin of LGI bleed
52
What are the most common causes of small bowel Lower GI bleed?
``` Meckel's Diverticulum SI Angiodysplasia SI tumour/GIST SI ulceration Aortoentero fistulation ```
53
What does an aortoentero fistulation commonly follow?
AAA repair
54
What small bowel investigations would be performed on a patient with acute Lower GI bleed?
CT Angiogram Meckle's scan Capsule endoscopy Double baloon enteroscopy
55
What is Meckel's diverticulum?
Gastric remnant mucosa of the vitelline duct
56
How is Meckel's diverticulum diagnosed?
Nuclear Scintigraphy
57
Where does Meckel's diverticulum form in the body?
2ft from the ileocaecal valve
58
How is acute GI bleed managed?
ABCDE Endoscopy within 24hrs Reverse/stop contributary meds Blood products?
59
What is shock?
Circulatory collapse resulting in inadequate tissue oxygen delivery leading to global hypoperfusion --> tissue hypoxia
60
How do you recognise haemorrhagic shock?
``` Tachypnoea Tachycardia Anxiety/confusion Clammy skin Oliguria Hypotension ```
61
How is shock classified?
Stages 1-4
62
How is stage 1 shock classified?
<15% blood loss RR<20 HR<100 Normal urine
63
How is stage 2 shock classified?
``` 15-30% blood loss RR 20-30 HR 100-120 Decreased pulse pressure Reduced urine output ```
64
How is stage 3 shock classified?
``` 30-40% blood loss RR 30-40 HR 120-140 Low BP Low pulse pressure Confusion Very low urine output ```
65
How is stage 4 shock classified?
``` >40% blood loss RR >40 HR >140 Low BP Low Pulse pressure Confused/drowsy No urine output ```
66
How is risk in Upper GI bleed classified?
Rockall score
67
What does the Rockall score classify?
Risk of re-bleed | Risk of death
68
How is the need for endoscopy in Upper GI bleed classified?
``` (Blatchford score) Urea Hb BP Heart/liver disease ```
69
What other factors increase the risk to a patient with Lower GI bleed?
``` Age Co-morbidity Inpatients Shock/frank bleeding Drugs (NSAIDs, Aspirin) ```
70
How are bleeds caused by peptic ulcer managed?
PPIs Endoscopy + endotherapy Angiography with embolization Laparotomy
71
What is the purpose of endoscopy for UGI bleeding caused by peptic ulcer?
Identify risk of further bleed Look for cancers Endoscopic therapy
72
What are the endoscopic therapy options for peptic ulcer?
``` Injection (adrenaline) Thermal (gold probe) Mechanical (clip) Haemospray Combination therapy ```
73
If a peptic ulcer cannot be controlled endoscopically, what is the next line of treatment?
Angiography + embolisation | Laparotamy
74
What are the management options for upper GI bleeds caused by varices?
Endotherapy: Glue injection, band ligation IV Terlipressin IV Broad spec. antiB
75
What is the role of IV Terlipressin?
Vasoconstrictor of splanchnic blood supply | (reduces blood flow to the
76
What treatment is indicated in varices bleeding, not controlled at UGIE?
Sengstaken-Blakemore tube + Transjugular intrahepatic porto-systemic shunt
77
What is coffee ground vomit?
Brown vomit, not always GI bleed, often systemic illness
78
Magenta stools suggest what?
Bleeding from right colon or distal ileum
79
What is haematochezia?
Passage of fresh/altered blood PR | Upper GI "fast transit" or lower GI

GI PATHOLOGY (20 decks)

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