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Gastrointestinal pathophysiology > Gastrointestinal blood loss > Flashcards

Gastrointestinal blood loss Flashcards

1
Q

What is the most common site of GI bleeding?

A

Upper GI tract (oesophagus, stomach and duodenum) – 70% of the time

  • 30% is large bowel GI bleeding
  • <1% is small bowel GI bleeding
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2
Q

What is the most likely cause of upper GI bleeding?

A

Peptic ulcer

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3
Q

Most common cause of large bowel bleeding?

A

Angiodysplasia

Diverticular disease

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4
Q

How will a patient present with an acute bleed?

A
  1. Haematemesis
  2. Malaena
  3. Shock
  4. Pr bleed
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5
Q

How will a patient with chronic bleeding present?

A
  1. Anaemia
    - Fatigue
    - SOB or chest pain
    - incidental
  2. Positive FOB (fecal occult blood)
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6
Q

Which examination would you do for chronic bleeding?

A

Abdominal

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7
Q

Which tests would you do for chronic bleeding investigation?

A 
FBC
U&E
Haematinics
Coeliac screen
Endoscopy/colonoscopy/CT colonography
Capsule/CT or MR enterography
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8
Q

What are the main steps of resuscitation? (ABC)

A
  1. Airway - aspirate blood from pharyx
  2. Blood - Take blood for X-match and other bloods
  3. Circulation - IV access - IV fluids
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9
Q

Which factors predict those with a significantly high risk of dying from an upper GI bleed?

A
  1. Age >65 yrs
  2. IHD, COAD, cirrhosis
  3. Chronic lung disease
  4. Shock on admission (pulse >100bpm, bp<100 or postural drop)
  5. Ascites
  6. Continued bleed
  7. Re-bleeding
  8. Hb <8g on admission
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10
Q

What are the score systems for GI bleeding?

A
  1. Rockall

2. Blatchford

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11
Q

What is the advantage of using the Blatchford scoring system over the Rockall?

A

Blatchford does not require an endoscopy

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12
Q

What does the Rockall scoring system take into account?

A
  1. Age
  2. Pulse
  3. Blood pressure
  4. Comorbidity
  5. Endoscopic diagnosis and stigmata
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13
Q

What does the Blatchford scoring system take into account?

A
  1. Urea
  2. Hb
  3. BP
  4. Pulse
  5. Presentation: melaena or syncope
  6. Cardiac or liver diseases
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14
Q

What is the first line treatment for an upper GI bleed?

A

Therapeutic endoscopy

  • Aspirate blood from stomach
  • Endoscopic intervention to look for ulcers, active bleeding and varices all of which would require endoscopic intervention
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15
Q

What does endoscopic therapy consist of? (for bleeding ulcers)

A
  1. Injection
    - Adrenaline
    - Sclerosants
    - Thrombin/fibrin glue
  2. Electrocoagulation
  3. Clips
  4. APC (argon plasma coagulation) - particularly used for angiodysplasia
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16
Q

How do you treat bleeding varices?

A

Endoscopic therapy

- Suck it up and place an elastic band around it (banding)

17
Q

What are the first-line investigations for an acute lower GI bleed?

A
  1. Normal upper GI endoscopy (just to make sure the upper GI tract is fine)
  2. Colonoscopy
    - Endoscopic therapy can be applied during procedure
    - Determine the cause of bleeding
    - Determine prognosis
  3. Angiography
    - CT or MR angiography with contrast (most easy) - allows determination of where the blood loss within the bowel is coming from
    - Femoral angiography
    - Angiographic intervention
18
Q

How do you treat angiodysplasia during a colonoscopy via endoscopic therapy?

A

Injection and thermal methods

19
Q

How do you treat polyps during a colonoscopy via endoscopic therapy?

A

Diathermy and excision

20
Q

Management of acute bleeding

A
  • Resuscitate (ABC)
  • Clinical assessment - high risk or low risk
  • Initial investigations: RBC, clotting studies, X-match, EUGs, ECG
  • Endoscopy
  • Medical therapy
  • Surgery when indicated
21
Q

Management of chronic bleeding

A
  • History
  • Clinical examination
  • Abdominal examination
  • PR
  • Rigid sigmoidoscopy
  • Blood test including RBC, U&E, haematinics
  • Endoscopy, colonoscopy, CT colonography
  • Capsule, CT, or MR small bowel
22
Q

Management of varices

A
  1. Monitor on ITU
    - central line
    - urine output
    - regular FBC, clotting, creatinine, electrolytes, blood gasses
  2. Replace clotting factors: FFP, platelets etc
  3. Vasopressin, glypressin
  4. Somatostatin, octreotide
  5. Endoscopy: sclerotherapy or banding

Gastrointestinal pathophysiology (22 decks)

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