GI Bleeding

Question 1

ligament of Treitz

Answer 1

thin band of tissue that supports the end of the duodenum and the beginning of the jejunum

Question 2

GI bleeding above the ligament of treitz

Answer 2

malaena, blood in vomitus

Question 3

GI bleeding below the ligament of treitz

Answer 3

fresh/altered blood

Question 4

causes of upper GI bleed

Answer 4

duodenal ulcer
gastric ulcer
gastritis
varices
mallory-weiss
other less common causes

Question 5

typical presentation of someone with duodenal ulceration

Answer 5

healthy
normal appetite
waking in the middle of the night with RUQ pain
pain relieved by food

Question 5

other less common causes of upper GI bleeds

Answer 5

oesophagitis
duodenitis
tumour
dieulafoy
aortoduodenal fistula

Question 6

typical presentation of someone with duodenal ulceration

Answer 6

healthy
normal appetite
waking in the middle of the night with RUQ pain
pain relieved by food
never malignant

Question 7

typical presentation of someone with a gastric ulcer

Answer 7

thin/anaemic
afraid to eat
never pain at night
deep epigastric pain
pain on eating
vomiting eases pain
10% malignant

Question 8

typical presentation of a mallory-weiss tear

Answer 8

male
alcohol intake
migraine/vertigo
initial vomit is normal, subsequent vomit creates haematemesis
90% settle

Question 9

causes of oesophagitis

Answer 9

reflux
scalds
burns
infective

Question 10

dieulafoy’s lesion

Answer 10

large tortuous arteriole most commonly in the stomach wall that bleeds
can present anywhere in the GI tract

Question 11

causes of lower GI bleeding

Answer 11

ano rectal conditions eg. haemorrhoids, fissure, sepsis
inflammatory bowel disease
diverticular disease
malignancy
angiodysplasia

Question 12

lower GI bleeding is 60% due to

Answer 12

ano rectal conditions eg. haemorrhoids, fissure, sepsis

Question 13

angiodysplasia

Answer 13

abnormal tortous dilated small blood vessel in the mucosal wall and submucosal layers of the GI tract
difficult to diagnose

Question 14

if an angiodysplasia lesion is detected

Answer 14

treatment with coagulation

Question 15

diverticular disease

Answer 15

common
usually self limiting
may require surgery

Question 16

management of upper Gi bleeding

Answer 16

Airways:remove clots from airways
Breathing:supplemental oxygen to assist breathing
Circulation:isotonic fluid

Question 17

medical therapy for bleeding ulcer

Answer 17

IV PPI
eradicate helicobacter pylori
endoscopy

Question 18

factors increasing likelihood of re-bleed after medical therapy of bleeding ulcer

Answer 18

patient factors: shock, ongoing bleeding, Hb > 10 on admission, age >60
ulcer factors: visible vessel, clot in base, active bleeding, black/red spots, left gastric or duodenal artery territory ulcer

Question 19

surgery for bleeding ulcer

Answer 19

indicated if there is massive exsanguinating bleed or if there ia a rebelled in a person over 60
under-run or gastrectomy

Question 20

difference between an under run and a gastrectomy

Answer 20

under-run is simple quick and safe
gastrectomy is a big operation which should be avoided

Question 21

things on exam that indicate portal hypertension

Answer 21

ascites
umbilical hernia
hairless
distended veins

Question 22

causes of portal hypertension

Answer 22

pre- hepatic: thrombosis of portal vein
hepatic: cirrhosis (90% of the time)
post-hepatic: budd-chiari thrombosis hepatic veins

Question 23

medical management of varices

Answer 23

drugs
terlipressin
octreotide
balloon tamponade
Minnesota tube

Question 24

minnesota tube

Answer 24

oesophageal balloon
gastric balloon
oesophageal channel
gastric channel

Question 25

balloon tamponade

Answer 25

inserted mouth/nose
inflated <24 hours

Question 26

Transjugular portasystemic shunt

Answer 26

A transjugular intrahepatic portosystemic shunt (TIPS) connects the portal vein to the hepatic vein
bypasses cirrhotic liver which causing blockage due to scar tissue which is the cause of the portal hypertension

Question 27

management of lower GI bleeding

Answer 27

similar to upper GI

Airways: support if unconscious
Breathing:supplemental oxygen to assist breathing
Circulation:isotonic fluid

Question 28

if lower GI bleed patient is stable

Answer 28

investigate with colonoscopy
+/- angiography if actively bleeding or red cell scan
treat underlying cause

Question 29

if lower GI bleed patient is unstable

Answer 29

Aggressive resuscitation
Blood
Correct coagulation

CT angiogram to localise source of bleeding
emergency surgery - segmental resection if source localised
subtotal colectomy and end ileostomy if source not found