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Mariam Alimentary > Acute GI bleeds > Flashcards

Acute GI bleeds Flashcards

1
Q

We divide GI bleeds into upper and lower, what do we use as the boundary?

A

The ligament of treitz

Which connects the stomach to the junction of duodenum/jejunum

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2
Q

How does an upper GI bleed present?

A

Depends on the location

  • Haematemesis
  • Melaena
  • Elevated urea
  • Often associated with dyspepsia, reflux & epigastric pain
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3
Q

What causes elevated urea in a GI bleed?

A

partially digested blood

  • > Ammonia
  • > absorbed and broken down to urea
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4
Q

Whats the most common cause of upper GI bleeding?

A 
Oesophageal:
Ulcers
Varicies
Malignancies
Oesophagitis
Mallory Weiss tear- oesophageal tear
Stomach:
Peptic ulcer
Gastritis
Malignancy
Varicies 
Dieulafoy 
Angiodysplasia- chronic

Duodenum:
Itis
Ulcer
Angiodysplasia

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5
Q

List some other causes of upper GI bleeds?

A

Oesophagus:
Varices - Mallory Weiss Tear - Malignancy

Stomach:
Gastric Varices - Malignancy - Dieulafoy - Angiodysplasia

Duodenum:
Angiodysplasia

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6
Q

What is angiodysplasia

A

A small vascular malformation of the gut

Associated with chronic cardiovascular disorders, mainly valvular abnormalities/replacements.

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7
Q

How does a peptic ulcer present?

A
  • Dyspepsia
  • Weight loss
  • Collapse
  • Low urine output
  • Large volume Melaena
  • Haematemesis
  • Nausea/vomiting
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8
Q

What are hte risk factors for peptic ulcer disease?

A
  • NSAIDs/Steroids/Anti-coagulants/Anti-platelets
  • Alcohol & Smoking
  • Past history of liver disease
  • Family history of peptic ulcers or H pylori infection
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9
Q

How does a peptic ulcer arise?

A

Imbalance of damage vs protective stomach lining

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10
Q

What could cause excess gastric acid leading to a peptic ulcer?

A

Zollinger-Ellis Syndrome

Which is a gastrin-secreting pancreatic tumour

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11
Q

When would a case of gastritis or duodenitis or oesophagitis be likely to bleed?

A

IF theres impaired coagulation:

  • Medical Conditions
  • Anti-coagulants
  • Anti-platelets
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12
Q

What the common causes of oesophagitis?

A
  • Reflux
  • Hiatus Hernia
  • Alcohol
  • Biphosphonates
  • Systemic Illness
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13
Q

What tends to cause oesophageal varices and when are they most likely to lead to life-threatening bleeding?

A

Portal hypertension which is usually due to liver cirrhosis.

A sudden rise in portal pressure such as an infection or drug use can lead to severe bleeding

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14
Q

What is a mallory-weiss teat and how do we treat it?

A

A linear tear at the gastroesophageal junction, it usually follows a period of retching or vomiting

Most heal spontaneously but 10% require endoscopic treatment

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15
Q

What is diuelafoys lesion?

A

A submucosal arteriole becomes large and tortuous before eroding through the mucosa and bleeding into the gut
Most commonly in the gastric fundus

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16
Q

How do most lower GI bleeds present?

A
  • Fresh blood/clots in stool
  • Magenta Stools
  • Typically painless (no somatic innervation down there)
  • More common in advanced age
17
Q

What are the common causes of a lower GI bleed?

A
  • Diverticular Disease
  • Haemorrhoids
  • Vascular Malformations e.g. angiodysplasia
  • Neoplasia e.g. carcinomas or polyps
  • Ischaemic Colitis
  • Radiation enteropathy/proctitis
  • IBD (UC/CD)
18
Q

How do we diagnose the source of a lower GI bleed?

A

Colonoscopy

19
Q

What is diverticular disease?

A

Protrusion of the inner mucosal lining through the outer muscular layer forming a pouch
Diverticulosis = presence of disease
Diverticulitis = Inflammation

20
Q

What are haemorrhoids?

A

Enlarged vascular cushions around the anal canal they can become very painful if theyre below the dentate line.
Associated with constipation, straining & a low fibre diet

21
Q

What is ischaemic colitis?

A

A blockage of one of the vessels supplyig the colon leading to tissue ischaemia.
This results in crampy abdominal pain and is usually self-limiting.
However it can be complicated by gangrene or perforation.

22
Q

Hw does ischaemic colitis appear on endoscopy?

A

The mucosa is swollen and dusky blue

23
Q

What causes radiation proctitis and how does it present?

A

A previous histroy of radiotherapy, usually for cervical cancer or prostate cancer.
Crescendo rectal bleeding

24
Q

How do we treat radiation proctitis?

A

= Argon Plasma Coagulation - An endoscopic procedure
= Sulcrafate Enemas
= Hyperbaric O2

25
Q

Common small bowel causes of GI bleeds?

A
  • Meckel’s Diverticulum, gastric remnant mucosa
  • Angiodysplasia
  • Tumour
  • ulceration associated with NSAIDs
  • Aortoentero fistula
26
Q

What investigations can we do if we suspect a bleed to be from a small bowel source?

A
  • CT angiogram
  • Meckels Scan (scintigraphy)- gamma scan
  • Capsule enterography
  • Double balloon enteroscopy
27
Q

How do we classify shock, particularly the haemorrhagic subtype?

A 
Classified into 4 stages
The haemorrhagic subtype is characterized by:
- Tachycardia
- Tachypnoea
- Anxiety/confusion
- Cool clammy skin
- Oliguria (low urine output)
- Hypotension
28
Q

How do stratify risk in an upper GI bleed?

A

Glasgow-Blatchford bleeding Score. A score >5 indicates >50% risk of needing intervention

Theres no validated system for scoring lower GI bleeds

29
Q

How do we treat bleeds from a peptic ulcer?

A
  • PPIs
  • Angiography with embolization
  • Laparotomy
  • Endoscopy with endotherapy
30
Q

What types of endotherapy are there for a peptic ulcer

A
  • Adrenaline injection
  • Thermal contact with a “gold probe”
  • Mechanical Clip
  • Haemospray

Combination is most effective, the best is adrenaline with clips or thermal contact

31
Q

What forms of endotherapy are there for varices?

A
  • Band Ligation

- Glue Injection

32
Q

Other than endotherapy how else do we treat varices?

A
  • IV Terlipressin
    A vasocontricter of splanchnic blood supply which reduces portal venous flow lowering portal pressure
  • IV Broad spectrum antibiotics if theres a systemic infection
33
Q

How do we respond to uncontrolled variceal bleeding?

A

A temporary Sengstaken-Blakemore tube. It includes a gastric & oesophageal balloon to compress the veins.

Then put in a transjugular intrahepatic porto-systemic shunt. Connects portal & hepatic vein with liver to lower portal pressure

34
Q

What can cause the appearance of melaena?

A

Bismuth containing products e.g. pepto-bismol or iron supplements can make the stools dark or black

35
Q

What is haematochezia?

A

Passage of fresh or unaltered blood per rectum
Vs haematemesis which is from mouth
Vs Maelana which is thick sticky dark faeces containing partially digested blood

36
Q

Define Dyspepsia?

A

Epigastric discomfort, may be exacerbated by eating.

“Indigestion”

Mariam Alimentary (43 decks)

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