CT 1.2 Bleeding Flashcards
whats the mortality rate for upper GI bleeding
10%
what are some of the causes of upper GI bleeding
peptic and duodenal ulcers
gastric erosions
mallory weiss tears
varices
malignancy
oesophagitis
if a patient presenting with a bleed is unstable what steps should be taken
give o2
obtain large bore IV access
crystalloid solution as a bolus of 500mL in less than 15 min
NEWS
insert catheter and monitor output
when transfusing what factor can be given when every other method fails
recombinant factor VIIa
what is the glasgow blatchford score used for
predicts the need to treat those with upper GI bleeding
what is the rockall score used for
after endoscopy it predicts patients risk of re-bleeding and mortality
what is given to patients with suspected cirrhosis or variceal bleeding
IV Terlipressin (it is an analogue of vasopressin/ADH which is a vasoconstrictor)
or somatostatin/octreotide
what is a temporary measure to control variceal bleeding which allows for patient to stabilise and undergo endoscopy
balloon tamponade
what can be done during endoscopy to control oesophageal varices
band ligation
stent insertion
TIPS transjugular intrahepatic portosystemic shunts (decrease pressure in the portal system)
treatment of gastric varices
endoscopic injection of cyanoacrylate (sclerotherapy)
if not controlled with above TIPS
what form of imaging is used to determine which vessel is bleeding
CT angiography
peptic ulcer bleeding resolves spontaneously 80% of the time. If it doesnt what should be done
CT angiography and embolisation therapy during endoscopy
treatment of acute haemorrhagic gastritis
stop NSAIDs
PPIs, h2 receptor blockers
give anti h.pyrlori therapy
if bleeding continues: IV somatostatin
last resort: gastrectomy
what are common causes of lower GI bleeding
diverticulosis
AV malformation
colitis
neoplasia
upper GI source
SI source
benign anorectal disease
what score determines whether you should or should not admit with lower GI bleeding
oakland score <8 can go home
