GI Bleeding

Question 1

What is it called when there is vomit in the blood?

Answer 1

Haematemesis

Question 2

What is it called when there is blood in the faeces?

Answer 2

Melaena

Question 3

What is the most common cause of GI bleeding?

Answer 3

Duodenal ulcer

(followed by gastric erosions, gastric ulcers, varices….)

Question 4

Which factors can indicate the severity of haemorrhage?

Answer 4

• sBP < 100mmHg
• Pulse > 100bpm
• Hb < 100g/l
• Age > 60
• Comorbidities
• Postural drop in BP

Question 5

Why is it often young people that are more dangerous during haemorrhage?

Answer 5

They have much more compliant ANS so can compensate and appear well up until the last possible second when they eventually crash

Old people will show a gradual decline so give many early warning signs

Question 6

Why must endoscopy be done as soon as possible after bleeding?

Answer 6

Cause must be identified

Therapeutic management

Risk of re-bleeding can be assessed

Question 7

Recent haemorrhage has which three key signs?

Answer 7

1. Active bleeding or oozing
2. Overlying clot
3. Visible vessel

Question 8

What are the potential treatment options for GI bleeding?

Answer 8

• Endoscopic
• Acid suppression - PPI
• Interventional radiology
• Surgery
• H. pylori eradication

Question 9

What is the PPI of choice?

Answer 9

Omeprazole

Question 10

Acute variceal bleeding is as a result of what?

Answer 10

Portal hypertension

Question 11

What is the TIPSS procedure?

Answer 11

A resue therapy

A wire is inserted through the hepatic vein which has pressure sensors to detet the portal vein

A balloon passes via the vein allowing a stent to be insterted

Bleeding in the varices stops because there is no longer a driver for the bleeding - pressure is normalised