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Gastrointestinal Pathology > Acute GI Bleeding > Flashcards

Acute GI Bleeding Flashcards

1
Q

What areas affected can cause upper GI bleeding?

A

Oesophagus
Stomach
Duodenum

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2
Q

Upper GI bleeding location in relation to the ligament of Tritez

A

Proximal

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3
Q

Lower GI bleeding location in relation to the ligament of Tritez

A

Distal

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4
Q

What areas affected can cause lower GI bleeding?

A

Distal to duodenum

  • jejunum
  • ileum
  • colon
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5
Q

Causes of oesophageal bleeding

A

Oesophageal varices
Mallory Weiss Tear
Oesophageal malignancy
Ulcers

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6
Q

Causes of stomach bleeding

A 
Gastric varices
Gastric malignancy (may be under an ulcer)
Dieulafoy 
Angiodysplasia (tends to be chronic)
Ulcers
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7
Q

Causes of duodenal bleeding

A

Ulcers

Angiodysplasia (chronic)

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8
Q

When does inflammation in the upper GI tract tend to bleed?

A

In the context of abnormal clotting

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9
Q

Most common causes of an acute upper GI bleed

A 
Gastric cancer
Peptic ulcer 
Mallory-Weiss teat
Oesophagitis
Duodenitis
Varices
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10
Q

What is a Mallory-Weis tear?

A

A linear tear in the mucous membrane where the oesophagus meets the stomach (oesophago-gastric junction)

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11
Q

What does melaena indicate?

A

Upper GI bleeding

As blood is digested and passed through

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12
Q

What does an elevated urea indicate in bleeding?

A

Partially digested blood > haem > urea = Upper GI bleeding

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13
Q

What are upper GI bleeding associated symptoms?

A

Dyspepsia
Reflux
Epigastric pain

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14
Q

Common cause of upper GI bleeding

A

NSAID use e.g. ibuprofen

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15
Q

Presentation of upper GI bleeding

A

Haematemesis
Melaena
Elevated urea

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16
Q

Presentation of lower GI bleeding

A

Fresh blood / clots
Magenta stools
Normal urea (rarely elevated in proximal small bowel)
Typically painless

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17
Q

Who is lower GI bleeding more common in?

A

Advanced age

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18
Q

Presentation of a peptic ulcer with an acute upper GI bleed

A 
Dyspepsia
Weight loss 
Collapse
Poor urine output
Large volume melaena or haematemesis
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19
Q

Which of duodenal or gastric ulcers are more common?

A

Duodenal

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20
Q

Risk factors for peptic ulcers

A

H pylori
NSAIDs/Aspirin
Alcohol excess
Systemic illness - “stress ulcers”

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21
Q

What may gastric ulcers sit over?

A

Gastric carcinoma

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22
Q

What is Zollinger-Ellison syndrome and what does it cause?

A

Gastrin secreting pancreatic tumour

Causes recurrent poor healing duodenal ulcers

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23
Q

When does gastritis and duodenitis tend to bleed?

A

In the context of impaired coagulation

  • medical conditions
  • anti coagulants (e.g. warfarin)
  • anti platelets (e.g. clopidogrel)
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24
Q

Causes of oesophagitis causing upper GI bleeding

A 
Reflux oesophagitis
Hiatus hernia
Alcohol 
Bisphosphonates
Systemic illness 
Anti platelets/coagulants
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25
Q

What are varices secondary to?

A

Portal HTN, usually due to liver cirrhosis

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26
Q

What are varices?

A

Abnormally dilated collateral vessels

27
Q

Where are varices commonly found?

A

Oesophageal (90%)
Gastric (8%)
Rectal and splenic (rare)

28
Q

Presentation of a Mallory-Weiss tear

A

Period of retching / vomiting

Haematemsis / melena

29
Q

What is diuelafoy?

A

Submucosal arterial vessel eroding through the mucosa

Gastric fundus

30
Q

What is an angiodysplasia?

A

Vascular malformation - degeneration, friable and bleeds easily

31
Q

Where does an angiodysplasia occur?

A

Anywhere in the GI tract

32
Q

What type of bleeding can angiodysplasia cause?

A

Chronic occult or overt occult bleeding

33
Q

Colonic causes of acute lower GI bleeding

A 
Diverticular disease
Haemorrhoids
Vascular malformation (angiodysplasia)
Neoplasia (carcinoma or polyps)
Ischaemic colitis
Radiation enteropathy/proctitis 
IBD
34
Q

Investigations of lower GI bleeding

A

Flexible sigmoidoscopy

Full colonoscopy

35
Q

What is diverticular disease?

A

Protrusion of the inner mucosal lining through the outer muscle layer forming a pouch

36
Q

Diverticulosis vs diverticulitis

A 
Diverticulosis = presence
Diverticulitis = inflammation
37
Q

Bleeding in diverticular disease

A

10-20% during lifetime
10% chance of recurrence at 1 year
25% chance of reoccurrence at 4 years

38
Q

What % of diverticular disease is self limiting?

A

75%

39
Q

What are haemorrhoids?

A

Enlarged vascular cushions around the anal canal

40
Q

When do haemorrhoids become painful?

A

If thrombosed

If external

41
Q

Associations of haemorrhoids

A

Straining
Constipation
Low fibre diet

42
Q

Treatment of haemorrhoids

A

Elective surgical intervention

43
Q

What is ischaemic colitis?

A

Disruption to the blood supply in the colon

44
Q

Complication of ischaemic colitis

A

Gangrene

Perforation

45
Q

What type of abdominal pain presents with ischaemic colitis?

A

Crampy abdo pain

46
Q

What does the mucosa look like in ischaemic colitis?

A

Dusky blue

Swollen mucosa

47
Q

Radiotherapy for what commonly can cause radiation proctitis?

A

Cervical cancer

Prostate cancer

48
Q

Treatment of radiation proctitis

A

APC
Sulcrafate enemas
Hyperbaric oxygen
May need blood transfusion due to chronic loss

49
Q

Small bowel causes of acute lower GI bleeding

A 
Meckel's diverticulum 
Small bowel angiodysplasia
Small bowel tumour/GIST
Small bowel ulceration (NSAID assosiated)
Aorto-entero fistulation
50
Q

Investigations for a small bowel cause of acute lower GI bleeding

A

CT angiogram
Meckles scan
Capsule endoscopy
Double balloon enteroscopy

51
Q

Major haemorrhage protocol for GI bleeding

A
  1. Resus with ABCDE approach
  2. Consider blood transfusion if Hb < 7g/dl
  3. Risk stratification for placement in HDU
  4. Endoscopy once stable - within 24 hours
  5. Withhold/reverse contributory medications as able e.g. vit K if on warfarin
  6. Specific meds
    7 Consider CT angiography/interventional radiology/surgical intervention as appropriate
52
Q

What is shock?

A

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

53
Q

Signs of shock dude to haemorrhage

A 
High RR 
High HR
Anxiety or confusion 
Cool clammy skin 
Low urine output
Low BP
54
Q

What risk stratification scores are used for upper GI bleeding?

A

Rockall score

Blatchford Score

55
Q

What does the Rockall score look at?

A 
Age 
Shock 
Co-morbidity
Diagnosis
Major stigmata of recent haemorrhage
56
Q

What does the Blatchford score look at?

A 
Pre endoscopy score
- blood urea
- Hb
- BP
- hepatic disease
- cardiac failure
Then decide if need endoscopy
57
Q

Who does acute lower GI bleeding most commonly occur in?

A

Elderly

58
Q

The presence of how many co morbid conditions doubles the chances of a severe bleed?

A

2

59
Q

Treatment of GI bleeding due to a peptic ulcer

A

PPIs
Endoscopy with endotherapy
Angiography with embolization
Laparotomy

60
Q

Treatment of upper GI bleeding due to variceal bleeding

A 
Endotherapy
Oesophageal band ligation or glue injection 
Gastric - glue injection 
Rectal - glue injection 
Ideally intubated for airway protection 
IV Terlipressin 
IV broad spectrum antibiotics
61
Q

What does IV terlipressin do?

A

Vasoconstrictor of sphlanchnic blood supply

- reduces blood flow to portal vein, reducing portal pressures

62
Q

What is used in the prophylaxis of variceal haemorrhage?

A

Propanolol

63
Q

Who is a Mallory weis tear common in?

A

Alcoholics

Gastrointestinal Pathology (26 decks)

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