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GI > Acute GI Bleeding > Flashcards

Acute GI Bleeding Flashcards

1
Q

What are the symptoms of upper GI bleed / important in the hX

A 
Haematemesis - bright red or coffee 
Epigastric pain 
Melaena - black motions (often foul / loose) 
Increased urea as haem broken down out of proportion to creatinine 
Anaemia 
Signs of shock / syncope 
Dyspepsia
Reflux
Tachy / ill before bleed 
Weakness

History of

  • Past GI bleed
  • Ulcers
  • Liver disease or varices
  • Drugs - NSAID
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2
Q

What causes upper GI

A

Oesophageal / gastric varices
Peptic / duodenal ulcer = most common
Mallory Weiss tear - self limiting after retching or vomit - 2nd most common
Malignancy
Gastritis / oesophagitis
Drugs - NSAID / SSRI / steroid / anti-coagulant

Rare
Aorta-enteric fistula after AAA repair 
Bleeding disorder 
Dieuloafoy lesion - large torturous arteriole 
Angiodysplasia 
Meckel's
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3
Q

What should you enquire about

A 
Dyspepsia
Dysphagia
Reflux
Signs of shock
NSAID / drug Hx
Past Hx of bleed / ulcers / GI bleed / varicose / alcohol
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4
Q

What puts you at increase risk of bleed

A 
Age >60 
Co-morid
Inpatient
NSAID
Anti-coagulant 
Liver disease
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5
Q

What is predictor of severity

A

Initial shock

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6
Q

What imaging and tests in acute setting

A

CXR / AXR
ECG
ABG
Do PR to look for maelana

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7
Q

What anaemia is suggestive of bleed

A

Iron

DO ENDOSCOPY

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8
Q

What other imaging

A

Balloon / MR enteroscopy - small bowel
CT angiogram
Meckelscan
CT CAP

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9
Q

What score is used for initial assessment

A

Blatchford - assess whether another bleed is likely and when endoscopy is needed

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10
Q

What score suggest admission / endoscopy

A

> 6

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11
Q

What does blatchford score take in

A 
Sex
Urea - rises as breakdown product which is absorbed into the intestines 
Hb
BP
Hepatic / cardiac failure
Tachycardia
Malaena
Syncope
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12
Q

What score is used after endoscopy to monitor risk of rebelled / predict mortality

A

Rockall

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13
Q

What does Rockall look at

A 
Age 
Pulse
BP
CVP
Urine
FBC, U+E, LFT, clotting
Co-morbid
Cause of bleed
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14
Q

How do you manage all upper G bleed

A

A - protect airway (can suction vomit)
B - 15l O2 NRB
C - IV access with 2 wide bore cannula, fluid, blood, FBC, U+E, LFT, cross-match, coag, transfusion if needed, VBG, regular BP monitor
D - catheter / fluid restrict
E - NBM / correct clotting / stop anti-coagulant / ECG / keep warm

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15
Q

When do you transfuse

A

Transfuse, blood, platelets and FFP if massive haemorrhage
Hb <70
Platelet <100 if major or 30 if minor
FFP if fibrongn <1 or PT > 1.5
Prothromin complex can be given to reverse warfarin

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16
Q

How do you monitor and what bloods

A

BP, Pulse, CVP

G+S or X-match
FBC, U+E, LFT, lipase
VBG
Clotting and INR

17
Q

What do you do when stable

A

Endoscopy if Blatchford >6
Immediate if severe or variceal bleed
Or within 24 hours of admission for other
Consider angiography / surgery if endoscopy fails to control / already been done 2x

18
Q

What do you give to reduce risk of further bleed

A

IV BB

19
Q

How do you treat varices

A

ABCDE as above
- Get clotting + FBC as probably deranged due to liver function and correct
If patient unstable = give O-ve blood as fluid will just dilute
Terlipressin + Iv Ax prior to endoscopy (Quinolone)
- Terlipressin = stabilises patient
Emergeny endoscopy within 4 hours
- If during the night will need to call someone in
- Band litigation or glue during endoscopy
Balloon tamponade if can’t get someone to do endoscopy + uncontrollable bleed
Sengansten Blackmore tube if all else fails
TIPS if that fails

20
Q

What do you give after endoscopy as prophylaxis

A

BB

Band ligation and PPI continuous infusion until eradicated

21
Q

How do you treat angiodysplasia

A

Colonosocpy to Dx
Argon phototherapy
Anti-fibinrolytic

22
Q

What does terlipressin do

A

Vasoconstriction of splanchnic blood supply

Reduce portal tension

23
Q

What bloods in rectal bleed

A 
QFIT
FBC, U+E, LFT, ferritin 
Coeliac
CRP
Calprotectin
DRE
24
Q

Signs of shock

A 
High RR / HR
Low BP
Low urine output
Anxiety
Confusion
Decreased GCS
Prolonged cap refil
Cool clammy skin
25
Q

What are more common causes of rectal bleed

A 
Diverticulitis
Malignancy - colorectal cancer 
Haemorrhoids
IBD
Perianal disease
Angiodysplasia
Gastroenteritis
26
Q

What are rare causes

A 
Trauma
Ischameic colitis
Radiation proctitis
Aorta enteric fistula following AAA repair
Meckels
27
Q

What are symptoms of lower GI bleed

A 
Fresh blood clot
Magenta stool
Normal urea
Anaemia
Painless
28
Q

How do you investigate lower GI bleed

A

DRE
Colonoscopy
Bloods
Angiogram if patient unstable to identify bleeding

29
Q

What bloods

A 
FBC, U+E, LFT, Ca, TFT 
Clotting
Amylase
CRP
Group and save
Stool MC+S
Coeliac
Calprotectin
QFIB
30
Q

What imaging

A

AXR if sign of sepsis / peritonitis

31
Q

How do you manage lower GI bleed

A 
ABCDE
Insert 2 cannula
Catheter 
Crystalloid replacemnt
Blood transfusion
Ax if sepsis / perforation
Start a stool chart 
Angiography+ embolization
CT angiography = non invasiv
Colonscopy
Surgery if massive
32
Q

Can you put bleeding down to haemorrhoids

A

Not without internal inspection as can be impalpable

33
Q

What artery affected

A

Gastroduodenal

34
Q

When should you consider admission

A

> 60
Co-mornid
Unstable
Aspirin / NSAID use

35
Q

Why do you do U+E

A

Colonoscopy require lots of laxatives before

36
Q

Why is ferritin useful

A

Drops before Hb

37
Q

What is TIPS

A

Connection between inflow portal vein and outflow hepatic vein
Used to reduce portal HTN

GI (29 decks)

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