GI Bleed

Question 1

LGIB

Answer 1

Massive bleed rare or DIVERTICULAR disease or ischaemic colitis.
Minor bleeds: haemorrhoids are common

Haemorrhoids
Anal fissure
Colon cancer
Colitis: UC, crohns, infective, ischaemic
Angiodysplesia (abn collection of blood vessels) 
Diverticular d
Polyps
Meckels diverticulim

Question 2

Mx

Answer 2

Large: resuscitation-> IV fluids, blood transfusion,
Then site must be determined:
Rectal examination - carcinoma?
Proctoscopy - haemorrhoids? (Rigid sigmoidoscopy)
Sigmoidoscopy (flex) -IBD
Barium enemas for mucosal lesions
Colonoscopy- dx + removal of polyps
Angiography- vascular abnorm- angiodysplesia

Question 3

Chronic GI bleed

Answer 3

Usually presents w/ Fe deficiency anaemia
Blood loss in all men
Women after menopause
Always result from bleeding from GI tract.

Oesophageal varices, DU and Diverticular D rarely bleed chronically.
Malabsortpion (esp coeliac), prevx gastrectomy+ poor dietary intake –> Fe def anaemia similar to anaemia due to chronic blood loss.

Inv
Top and tail at same endoscopic session- gastroscopy and colonoscopy- distal duodenal biopsy taken to exclude coeliac for anaemia

More if anaemia not responding to Fe tx or visible blood loss
1. Small bowel barium follow-through - help if crohns suspected- lesions
Small bowel enteroscopy and /or wireless capsule endoscopy.
Coeliac axis and mesenteric angiography
Technetium labelled red cell scan.

Mx
Tx + oral FeSO4 for anaemia.

Question 3

Rockall score for UGIB

Max 11

Answer 3

Age 80. 2

Shock none 0
Pulse >100 + systolic BP >100 1
Systolic