Gen surg - GI bleeds Flashcards
RF for peptic ulcer disease?
- H pylori
- NSAIDS
- SSRIS
- Steroids
- Bisphosphonates
- Zollinger-Ellison syndrome
- smoking
What is the best initial management for patients with high output stomas (4 points)?
Restrict oral hypotonic fluid intake, advise dextrose-saline solution, prescribe oral loperamide and omeprazole
What criteria are involved in the Glasgow-Blatchford score?
Anaemia, urea, BP, HR, melaena, syncope, hepatic disease, cardiac failure
What are the causes of an upper gastrointestinal bleed?
Variceal haemorrhage
Inflammation - oesophagitis, gastritis
Peptic ulcer disease
Malignancy
Mallory-Weiss tear
Dieulafoy’s lesion
Aorto-enteric fistula
causes of lower GI bleeding?
Vascular causes include angiodysplasia and ischaemic colitis.
Inflammatory causes include inflammatory bowel disease (Crohn’s disease and ulcerative colitis).
Infective causes include infectious colitis.
Neoplastic causes include colorectal cancer and anal cancer.
Anatomical anorectal causes include haemorrhoids and anal fissure.
Anatomical small bowel/colon causes include diverticular disease, Meckel’s diverticulum and colonic polyps.
Note that upper GI bleeding may cause a lower GI bleed (due to rapid transit).
Non-GI causes include endometriosis.
What is the difference between the use of the Glasgow-Blatchford score and the Rockall score?
The Glasgow-Blatchford score is used pre-endoscopy and the Rockall score can be used in patients post-endoscopy.
What does the Rockall score involve?
age, systolic blood pressure, pulse rate, comorbidities (before endoscopy) and diagnosis and signs of recent haemorrhage (after endoscopy)
Pt has occult GI bleeding and bloods show iron deficiency anaemia. What are next steps in managing this?
Pt needs colonoscopy and endoscopy
Symptoms of peptic ulcer disease?
- Epigastric pain
- Pain worse with eating- gastic ulcer
- Pain relieved by eating- duodenal ulcer
- Nausea and vomiting
- loss of appetitie
- unexplained weight loss
- if complicated - can present with coffee ground vomit.
- Pt can present with symptoms of being haemodynamically unstable - low BP, tachycardic, dizzy.
Inv of peptic ulcer disease?
- H. Pylori with urea breath test or stool
- if over 55 with weight loss and dyspepsia = need an urgent OGD (in 2wk) to assess for oesophageal and gastric cancer
- endoscopy = visualise ulcers. biopsies may be taken to rule out malignancy
Management of peptic ulcer disease?
- If no H pylori found- PPi until ulcer has healed as well as:
- smoking cessation
- reduce alcohol intake
- regular, small meals, avoiding eating 4 hours before bed
- avoid spicy foods, coffee
- weight loss if needed
- stress management
- Avoidance of NSAIDs, steroids, bisphosphonates, potassium supplements, SSRI
If H. pylori is found:
* PPI + amoxicillin + clarithromycin/metronidazole for 7 days
* if pt has associated NSAID use - take ppi for 8 weeks then eradication therapy.
If gastic ulcer found - repeat endoscopy in 6-8 weeks to ensure healing, and repeat H pylori testing.
How to eradicate H pylori?
- a proton pump inhibitor + amoxicillin + (clarithromycin OR metronidazole)
- if penicillin-allergic: a proton pump inhibitor + metronidazole + clarithromycin
Complications of peptic ulcer disease?
- Perforation
- Bleeding
symptoms of perforated peptic ulcer?
- sudden onset epigastric pain that becomes generalised
- syncope
Inv for perforated peptic ulcer?
- Xray- free air under the diaphragm
