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Medicine & Surgery: Gastroenterology > GI Bleeding > Flashcards

GI Bleeding Flashcards

1
Q

What is an upper GI bleed?

A

Blood loss whose origin is proximal to the ligament of Treitz at the duodenojejunal.

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2
Q

What are the manifestations of an upper GI bleed?

A

Haematemesis (active bleed), coffee ground emesis (slower) and melaena with or without haemodynamic compromise.

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3
Q

What are the manifestations of a lower GI bleed?

A

Haematochezia (bright red rectal bleeding) or blood mixed in with faeces helps localise where the bleed is.

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4
Q

What are the causes of an upper GI bleed?

A
  1. Peptic ulcer disease
  2. Varices
  3. Gastroduodenal erosions
  4. Mallory-Weiss tears
  5. Oesophagitis
  6. Malignancy (ALARM Signs)
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5
Q

What are the causes of lower GI bleed?

A
  1. Diverticular disease
  2. Angiodysplasia (small vascular malformation of the gut)
  3. Ischaemic colitis
  4. Inflammatory bowel disease
  5. Infectious colitis
  6. Colorectal cancer
  7. Haemorrhoids
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6
Q

What is this a presentation of?

Coffee ground vomit. NSAID/steroid use.

A

Peptic ulcer disease (blood lingering in the lumen allows oxidation of iron)

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7
Q

What is this a presentation of?

Brisk haematemesis, signs of liver disease or portal hypertension.

A

Variceal active upper GI bleed

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8
Q

What is this a presentation of?

Upper GI bleed which started as vomiting or retching without blood then blood appears.

A

Mallory-Weiss tear

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9
Q

What is this a presentation of?

Abdominal pain, diarrhoea, haematochezia.

A

Ischaemic or inflammatory colitis

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10
Q

What is the immediate management for a severe upper GI bleed?

A
  1. ABCDE, high flow oxygen
  2. 2 large bore cannulae
  3. FBC, U&Es, LFTs, clotting, crossmatch
  4. IV fluids (1-2L) or O Rh-ve if deteriorating.
  5. Transfuse 2 units with cross-matched blood if Hb <8.
  6. Correct clotting with vitamin K, FFP, platelets.
  7. IV Terlipressin 1-2mg/6hr if suspecting varices
  8. Urgent endoscopy, catheter, stop anticoagulation.
  9. Antibiotic prophylaxis
  10. Prevent encephalopathy
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11
Q

What is the management for rectal bleeding?

A
  1. ABCDE if necessary
  2. Treat cause
  3. History and examination
  4. FBC, U&Es, LFTs, clotting, cross-match
  5. AXR, erect CXR if signs of perforation
  6. IV access and catheterise
  7. Antibiotic cover if septic
  8. Withhold antiplatelet/anticoagulation
  9. Bed bound, stool chart
  10. If not settling conservatively - CT angiography, escalate to surgery
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12
Q

What scoring is used in Upper GI bleeding to assess mortality before and after endoscopy?

A

Rockall scoring system - admit all >0

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13
Q

Which medications are used in the prevention of peptic ulcer disease and varices rupture?

A
  1. PUD - PPIs

2. Varices - propranolol

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14
Q

What are the signs seen in a presentation of chronic liver disease causing portal hypertension?

A

Encephalitis with or without asterixis, spider angioma, gynaecomastia, hepatosplenomegaly, ascites, caput medusa, hypogonadism.

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15
Q

Which indication will help to identify an occult GI bleed?

A

Faecal occult blood test

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16
Q

What are haemorrhoids, how are they viewed, and in which positions can the three anal cushions be found?

A
  1. Disrupted and dilated anal cushions
  2. Viewed from lithotomy position
  3. 3, 7, and 11 o’clock
17
Q

What are the differentials for haemorrhoids?

A

Anal fissure, tumour

18
Q

What is the main cause of haemorrhoids?

A

Constipation with prolonged straining

19
Q

What is this a presentation of?
Bright red rectal bleed, often coated stools, on the tissue or dripping into the pan after defecation. May have mucous PR, and pruritic ani.

A

Haemorrhoids

20
Q

How are suspected haemorrhoids investigated in those >50 years old?

A

Abdominal exam, PR exam and colonoscopy.

21
Q

What is the classification system for haemorrhoids?

A
  1. 1st degree - remain in the rectum
  2. 2nd degree - prolapse through anus on defecation but spontaneously reduces
  3. 3rd degree - same as second but requires digital reduction
  4. 4th degree - remains permanently prolapsed
    Internal is above the dentate line external is below it.
22
Q

What is the treatment for a first degree haemorrhoid?

A

Increase fluid and fiber intake, topical analgesics.

23
Q

What is the treatment for a second and third degree or failed first degree haemorrhoid?

A

Rubber band ligation, sclerosants.

24
Q

What is the definitive treatment for a fourth degree haemorrhoid?

A

Excisional haemorrhoidectomy

Medicine & Surgery: Gastroenterology (42 decks)

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