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Gastrointestinal Block > Gastrointestinal bleeding > Flashcards

Gastrointestinal bleeding Flashcards

1
Q

An upper GI bleed referes to bleeding from which locations?

A

Oesophagus, stomach or proximal duodenum

Proximal to ligament of treitz

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2
Q

List the 3 key symptoms of an upper GI bleed

A
  1. Haematemesis
  2. Melaena
  3. Haematochezia
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3
Q

List 4 oesophageal causes of a UGIB

A
  1. Varices
  2. Neoplasm
  3. Oesophagitis
  4. Ulcer
  5. Mallory Weis tear
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4
Q

List 4 gastric causes of a UGIB

A
  1. Gastric Ulcer
  2. Neoplasm
  3. Gastritis
  4. Varices
  5. Dieulafoy’s lesions (large tortuous arteriole)
  6. Angiodysplasia
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5
Q

List 4 duodenal causes of a UGIB

A
  1. Duodenal ulcer
  2. Neoplasm
  3. Duodenitis
  4. Vascular malformations
  5. Aortoenteric fistulae
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6
Q

Which scoring system is used to predict the need for admission and timing of endoscopic intervention

A

Glasgow-Blatchford Score

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7
Q

Which scoring system is used to predict risk of re-bleeding and mortality

A

Rockall Score

Can be calculated pre and post endoscopy

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8
Q

What score should be used at 1st assessment to risk stratify

A

Blatchford

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9
Q

What is the Initial management of a Non-variceal bleed

A
  1. ABCDE
  2. Assess degree of shock
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10
Q

Management of a Non-variceal bleed?

A
  1. Fluid resuscitation
  2. Blood transfusion
  3. Vit K or Octaplex
  4. PPI, erythromycin, Tranexamic acid
  5. Endoscopy
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11
Q

Within what time frame is an endoscopy reccomended for UGIB?

Why?

A

Early endoscopy (within 24hrs)

For prompt diagnosis, risk stratification and haemostasis therapy

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12
Q

Endoscopic therapies for UGIB?

A

Aims to achieved Haemostasis by:

  1. Adrenaline injection + 2nd modality
  2. Thermal coagulation
  3. Mechanical–endoclips
  4. Hemospray
  5. (Glue/thrombin for varices)
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13
Q

What is the Forrest Classification?

A

ASK RISH

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14
Q

What is the only definitive way to treat oesophageal varicies?

A

TIPS - Transjugular intrahepatic portosystemic shunt

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15
Q

In what condition is Variceal bleeds most common?

A

Cirrhosis (50% of patients)

  • 30-40% in compensated disease
  • 85% in decompensated
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16
Q
A
17
Q

Initial management of a Variceal bleed?

A
  1. ABCDE
  2. Anaesthetist – consider intubation
  3. DOCC / ITU
  4. Gastro SpR/Cons on call (out-of hours)
18
Q

Management of a variceal bleed?

(Hint: VARICEAL B)

A
  1. Vasoconstrictor therapy
  2. Antibiotics
  3. Resuscitation
  4. ICU level care
  5. Endoscopy
  6. ALternative therapies
  7. Beta blockade
19
Q

What is the purpose of Vasoconstrictor therapy in management of a VB?

List an example of a medication used

A

Reduce splanchnic blood flow

eg. Terlipressin, Octreotide

20
Q

Why is it important to administer antibiotics in a VB?

List an example

A

Bacterial translocation occurs in 2/3 of cases → prophylactic antibiotics significantly reduces mortality

Broad spectrum: Tazocin

21
Q
A
22
Q

How soon should an endoscopy be performed following admission of a VB

What endoscopic therapies may aid treatment?

A

Urgent ASAP after resus! (Intubation often needed)

Therapy

  • Variceal band ligation
  • Tissue glue cyanoacrylate – gastric varix (we use thrombin)
23
Q

If an endoscopy cannot be performed in a VB, list 2 alternative / rescue therapies

CHECK THIS

A
  1. TIPS (Transjugular intrahepatic portosystemic shunt) → ↓ portal pressure and complications related to portal HTN
  2. Sengstaken-Blakemore Tube
24
Q

What is the purpose of Beta blockade in the management of VB?

List an example of a medication used

A

Reduces risk of recurrent VB

  • ↓ splanchnic vasoconstriction
  • ↓ CO

Non-selective β-blocker eg. propanolol or carvedilol

25
Q

Post endoscopic management of a non-variceal blead?

A
  1. For low risk ulcers – fed promptly, start oral PPI
  2. Forrest classification and risk of re-bleeding
  3. If endoscopic therapy – 72 hour PPI infusion
  4. If DU – give empirical HP eradication therapy
  5. Discharge on PPI (when Hb >8) and advise against NSAID use
26
Q

Post endoscopic management of a variceal blead?

A
  1. Continue antibiotics 5/7
  2. Wean terlipressin early after successful banding
  3. Beta blockade (secondary prophylaxis) in combo with
  4. Variceal banding programme - repeat OGD at 2-4wks until eradication achieved
27
Q
A
28
Q

Management in case of re-bleeds?

A

Repeat OGD +/- therapeutics

29
Q

Management If bleeding is uncontrolled?

A
  1. Interventional radiology – CT angiogram +/- embolisation vs. TIPSS
  2. Surgeons
  • Under running with or without pyloro-plasty
  • Local excision or partial gastrectomy
30
Q

A lower GI bleed referes to bleeding from which locations?

A

colon and rectum

31
Q

Is a patient with severe haematochezia more likley to be an UGIB or LGIB

A

UGIB - 15% of UGIB present as LGIB

32
Q

List 4 painLESS causes of a LGIB, highlight the most common

A
  1. Diverticular*
  2. Aortoenteric fistula*
  3. Malignancy
  4. Angiodysplasia–Heyde’s syndrome
  5. Haemorrhoidal
  6. Post-polypectomy
33
Q

List 4 painFULL causes of a LGIB

A
  1. Colitis (UC, Crohns, infectious)
  2. Ischaemic colitis
  3. Massive UGIB*
34
Q

Initial management of a LGIB

A
  1. ABCDE
  2. Stabilise and resuscitate (fluids/blood products)

These are usually self-limiting

35
Q

List 4 investigations for a LGIB

A
  1. OGD
  2. CT angiogram
  3. Flexible sigmoidoscopy vs colonoscopy
36
Q

List 3 Therpies for a LGIB that is not self-limiting

A
  1. Submucosal injections of adrenaline
  2. Clip / heat
  3. APC

Performed during a Flexible sigmoidoscopy or colonoscopy

37
Q

Under what circumstances would a LGIB require surgery?

A

Massive haemorrhage + haemodynamic instability → surgery

Gastrointestinal Block (26 decks)

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