GI Bleed

Question 1

what is Haematemesis

Answer 1

vomiting blood

- bleeding from upper GI tract

Question 2

causes of Haematemesis

Answer 2

oesophageal varices
peptic ulcers
mallory-weiss tears
Oesophagitis
gastric cancer

Question 3

what causes oesophageal varices

Answer 3

portal hypertension results in dilation of veins at porto-systemic anastomoses in oesophagus

• veins are swollen, thin walled and prone to rupture
• most commonly due to alcoholic liver disease causing portal HTN

Question 4

Investigation of patient with hx of alcohol abuse / known chronic liver disease

Answer 4

Urgent OGD

Question 5

what is a mallory weiss tear

Answer 5

episodes of severe vomiting followed by minor Haematemesis

• forceful vomiting causes tear in epithelial lining of oesophagus
• most resolve spontaneously

Question 6

what is Oesophagitis

Answer 6

inflammation of intraluminal epithelial layer of oesophagus

- most commonly due to GORD

Question 7

why might patients with GI bleed have a high urea

Answer 7

breakdown product of blood in the GI tract is urea – urea absorbed in the intestines

Question 8

score used for patients with suspected GI bleed

Answer 8

Glasgow-Blatchford score

Question 9

what is the Rockall Score used for

Answer 9

to calculate risk of rebleeding and overall mortality in patients who have had a GI bleed post OGD

Question 10

acute management of GI bleed

Answer 10

ABCDE

• 2 large bore cannulas
• crossmatch blood
• bloods: Hb, urea, LFTs, coagulation screen
• stop anticoagulants + NSAIDS

urgent OGD

Question 11

acute management of oesophageal varices

Answer 11

OGD + banding of varices
terlipressin / octeotride to decrease bleeding
- if unsuccessful a Sengstaken-Blakemore tube is inserted and inflated at the level of the varices to compress the bleeding

Question 12

what drugs are given in the acute management of oesophageal varices?
what do they do?

Answer 12

vasopressors - terlipressin or
somatostatin analogues - oceteotride
- reduce splanchnic blood flow to decrease the bleeding

Question 13

long term management of oesophageal varices

Answer 13

beta blockers to reduce portal pressure

repeated OGD banding of varices

Question 14

acute management of bleed caused by peptic ulcer

Answer 14

OGD + adrenaline injections + cauterisation
IV PPI (omeprazole 40mg) to reduce acid secretion
+/- H.Pylori Eradication

Question 15

buzz word for appearance of Haematemesis

Answer 15

“coffee ground vomit”

Question 16

what is Melaena

Answer 16

black tarry stools as a result of upper GI bleed

• offensive smell
• difficult to flush

Question 17

most common cause of malaena

Answer 17

peptic ulcer disease

Question 18

when should you suspect that peptic ulcer disease is the cause of malaena

Answer 18

patients with:

• known peptic ulcers
• NSAID use
• Dyspepsia symptoms
• H.Pylori +ve

Question 19

causes of malaena

Answer 19

peptic ulcer disease
varices
upper GI malignancy

Question 20

what key parts of examination must be performed in patients with malaena

Answer 20

PR

abdo exam

Question 21

definitive investigation of malaena

Answer 21

OGD

Question 22

what anatomical site marks an upper GI bleed

Answer 22

bleeding proximal to the ligament of Treitz

Question 23

large bleeds due to a peptic ulcer typically arise from which artery

Answer 23

gastroduodenal artery

- ulcer erodes through posterior gastric wall