Acute upper GI bleed Flashcards
What is haematochezia?
Fresh blood out of anus as opposed to old blood in melena
Signs and symptoms of acute upper GI bleed
Hematemesis Melena Hematochezia Syncope Presyncope Dyspepsia Epigastric pain Heartburn Diffuse abdominal pain Dysphagia Weight loss Jaundice
What investigations would you do?
BP Bloods: -FBC -Hb -Cross match -U and Es -Coagulation -Gastrin Endoscopy CXR Nasogastric lavage Angiography (if bleeding persists and endoscopy fails to identify a bleeding site)
Management
Fluids
Monitor urinary output- renal perfusion
Endoscopic haemostatic therapy for bleeding ulcers and varices
Surgical repair of perforated viscus
High dose IV PPI for high-risk peptic ulcer patients
What are the underlying mechanisms of GI bleed?
Arterial haemorrhage- ulcer or mucosal deep tear
Low-pressure venous haemorrhage- telangiectasias/angioectasias.
Variceal hameorrhage due to elevated portal pressure
Most common cause of an upper GI bleed?
Peptic ulcer diease- artery at the base of the ulcer is eroded
Is intervention always required to stop a bleeding peptic ulcer?
No, 80% stop spontaneously
Causes of bleeding
Mucosal tears of the esophagus or fundus (Mallory-Weiss tear) Erosive gastritis Erosive esophagitis Dieulafoy lesion Gastric cancer Ulcerated gastric leiomyoma Angiodysplasia (small vascular malformation of the gut- often an explanation for otherwise unexplained GI bleeding/anaemia) Aortoenteric fistula
Causes of mucosal tears (mallory-weiss tears)
Vomiting
Coughing
Straining
Causes of acute stress gastritis
Anything that alters levels of mucosal protective barriers (i.e. mucus, bicarbonate, blood flow, prostaglandins)
Most commonly patients with shock, multiple trauma, acute respiratory distress syndrome, systemic respiratory distress syndrome, acute renal failure, and sepsis.
Principle mechanisms: decreased splanchnic mucosal blood flow and altered gastric luminal acidity.
What is a dieulafoy lesion?
A vascular malformation of the proximal stomach. Associated with alcohol
Male:female?
2:1
Which risk factors increase mortality?
Age >60yo Severe comorbidity Active bleeding (witnessed haematemasis, red blood per NG tube, fresh blood rectum) Hypotension >6 units transfusion required Inpatient Severe coagulopathy
