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Gastro + hepatology > Bleeds, Ulcers & Diverticular diseae > Flashcards

Bleeds, Ulcers & Diverticular diseae Flashcards

1
Q

What is the risk score used for assessing the risk related to upper GI bleeds? What does it entail? WHAT IS IT GOOD FOR?

A

Glasgow-Blatchford Bleeding Score (GBS)

  • haemoglobin
  • BUN (bood urea nitrogen)
  • initial systolic BP
  • Sex
  • HR >100
  • melena
  • Recent syncope
  • Hepatic disease Hx
  • Cardiac Failure

Decision making tool for admission or discharge from A&E

0/1= low risk, >1 = higher risk & require admission + investigation

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2
Q

What are the typical symptoms of an Upper GI bleed?

A
  • Signs of circulatory insufficiency (tachy, hypotension)
  • melena
  • haematemesis

less specific:

  • retrosternal pain/other abdo discomfort
  • nausea
  • increased belching
  • dsyphagia
  • signs of anaemia from chronic bleeds
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3
Q

What are the typical symptoms of a lower GI bleed?

A
  • bright red bloody stool
  • rectal bleeding
  • may be melena

less specific:

  • retrosternal pain/other abdo discomfort
  • nausea
  • increased belching
  • dsyphagia
  • signs of anaemia from chronic bleeds
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4
Q

What are the main aetiologies of an Upper GI bleed?

A

Erosive/inflammatory:

  • gastric/duodenal ulcers
  • gastritis/duodenitis/oesophagitis
  • RF = GORD, NSAIDS/Aspirin, glucocorticoid steroids, Infections (H. Pylori)

Vascular:
-Oesophageal haemorrhage

Tumours

Traumatic/iatrogenic:

  • Mallory-Weiss tear
  • following endoscopcy/polypectomy
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5
Q

What are the main aetiologies of a lower GI bleed?

A

Erosive/inflammatory:

  • diverticulosis
  • IBD, Chrons, UC
  • infectious diarrhea

Vascular:

  • haemorrids
  • ischemia
  • rectal varices

Tumours:

  • colorectal & anal cancer
  • colon polyps

Traumatic/iatrogenic:

  • post polypectomy or biopsy
  • post-surgery anastomotic bleeding
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6
Q

What initial investigations do you in suspected upper GI or Lower GI bleed?

A

Upper GI signs:
-OGD

Lower GI signs:
-Colonoscopy

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7
Q

What is the Recommended management pathway for UGIB?

A
  • Glasgow-Blatchford Scale - 0-1 = non-urgent, >1 = admission + investigation
  • Resus with fluids, oxygen, RBC transfusion @ Hb of 70-80
  • Erythromycin - prokinetic (increase gastric emptying for better endsocopy)
  • PPI
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8
Q

How do you resus GI bleed patient?

A
  • 2 large bore canula in the cubital fossa

- crystallises first line - NORMAL SALINE

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9
Q

What is the other important scoring system for GI bleeds?

A

Rockall Score:
pre-endoscopy + post-endoscopy

pre-endoscopy score = mortality

0-3 - >2 exponential increase in risk

  • Age - (<60, 60-79, >80)
  • Shock - (Pulse + BP)
  • Comorbidity (Cardiac, GI Ca, major comorbidity - scores 2)
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10
Q

What endoscopic treatments are there?

A
  • adrenaline injection
  • ablative techniques
  • banding
  • mechanical devices
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11
Q

When & how to Post endoscopy PPI infusion?

A
  • Severe active bleed seen on scope

- 8mg per hour for 72 hours (omeprazole)

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12
Q

What are the risk factors for Gastric & duodenal ulcers?

A
  • H. Pylori infection
  • long term NSAID use
  • NSAID + steroid use
  • SSRIs
  • Smoking
  • Chronic alcohol consumption
  • > 65
  • Stress
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13
Q

How does H. Pylori effect the gastric mucosa?

A
  • Causes an increased acid production

- causes decrease in protective mucosal components

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14
Q

How do NSAIDs increase the risk of ulcers?

A

COX 1 & 2 inhibitors which cause a decrease in PGE2 that cuase a decrease in acid secretion & increases bicard + mucus secretion
-leads to mucosal erosion

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15
Q

What Sx are common to both Gastric & duodenal ulcers?

A
  • Dyspepsia - postrprandial heaviness, early satiety, gnawing, aching/burning epigastric pain
  • pain relief from antacids
  • secondary Sx from blood loss (anaemia, melena, haematemsis)
  • occult blood in stool
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16
Q

What Sx differentiate Gastric from duodenal ulcers & vice versa?

A
  • Gastric - pain increases shortly after eatin + weight loss
  • duodenal - pain increase 2-5 hours after eating/pain on empty stomach + weight gain
17
Q

How do you test for H.pylori?

A
  • OGD - biopsy and histology of ulcers seen on scope
  • Urea breath test - good for diagnostics and proof of Tx
  • H.pylori stool antigen - good for diagnostics and proof of treatment
  • serum antigen ain’t that great
18
Q

How you treat a H.pylori +ve patient?

A
  • TRIPLE THERAPY

- amox 7/7 + metronidazole (or clarythro) 7/7 + PPI (omep) 4-8/52

19
Q

If a patient with a peptic ulcer ISN’T H.Pylori +ve how do you treat them?

A
  • 4-8 weeks of PPI
  • stop causative agents
  • lifestyle advice
20
Q

Apart from bleeding, what is the other complication of peptic ulcer disease?

A
  • Gastric outlet obstruction
  • acute - oedema and inflammation
  • chronic - fibrosis and scarring
21
Q

What are the symptoms of gastric outlet obstruction?

A
  • postparandial NONbillious vomiting
  • early satiety
  • weight loss
  • sucussion splash
22
Q

How do mallory-weiss tears occur?

A

-sudden severe increase increase in the oesophageal luminal pressure causing a tear in the mucousal and submucosal vessels

23
Q

What conditions cause mallory-weiss tears?

A

SEVERE VOMITING

  • alcoholism
  • bulimia nervosa
  • hitial hernia
  • GORD
24
Q

What are the clinical features of a patient with a mallory-weiss tear?

A
  • could be asymptomatic
  • haematemesis
  • retrosternal pain
  • SHOCK
25
Q

How do you diagnose and treat a patient with a mallory-weiss tear?

A
  • OGD
  • OGD adrenaline or fibrin sealant injections
  • cauterisation - chemical, heat or electric

-may be able to treat conservatively IF it’s stopped bleeding

26
Q

What blood test MUST you do with any acutely bleeding patient?

A

-Group and save + crossmatch 2 units

27
Q

What’s the difference between a single diverticular, diverticulosis and diverticulitis?

A
  • diverticula - single outpouching of bowel containing all layers of the intestinal wall still in communication with the lumen
  • diverticulosis - multiple diverticular present throughout the bowel without any evidence of infection m
  • diverticulitis - infection of one or more diverticular
28
Q

What are the symptoms of diverticulosis?

A
  • abdominal discomfort

- chronic diarrhoea

29
Q

What are the symptoms of diverticulitis?

A

-Left iliac fossa pain + tenderness
-possible palpable mass in LIF
-acute constipation (50%)
-acute diarrhoea (30%)
-N&V
-acute abdomen = perf and peritonitis
-

30
Q

What are the tests to diagnose diverticulitis?

A
  • bloods - infection markers
  • CT abdo + pelvis + contrast

DONT SCOPE - risk of perf

31
Q

What follow up is needed for a patient following an episode of acute diverticulitis?

A

-6-8 post event FU colonoscopy to assess for potential malignancy

32
Q

How do you treat diverticulitis? Both Uncomplicated and complicated please?

A

Uncomplicated - oral broad spec ABX (cipro + metro)

Complicated - IV ABX, abscess drainage +/- surgery

33
Q

what life style advice would you offer to a patient with resolved diverticulitis?

A
  • HIGH fibre diet
  • LOW fat diet
  • lots of fluid hydration
  • vigorous exercise

Gastro + hepatology (20 decks)

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