GI Bleeding Flashcards
What is Maleana?
Black tarry stools that occur due to upper GI bleeding.
This can be anywhere from the nose to the ascending colon.
Where does GI bleeding most commonly occur?
In the upper GI tract which consists of the oesophagus, stomach and duodenum. It typically occurs due to:
-> ulceration in the stomach or the duodenum
-> varices
-> gastroduodenal erosion
What are the causes of small bowel bleeding?
Diverticulum of the jejunum or ileum.
Malignancy of the small bowel, due to increased angiogenesis.
What are the causes of large bowel bleeding?
Carcinoma
Polyp
Ulcerative colitis or Crohn’s disease
Angiodysplasia
What is angiodysplasia?
Swollen, dialated blood vessels on the mucosa and submucosa of the GI tract, which is more common in older adults due to the breakdown of blood vessels.
What is diverticulitis?
Inflammation of the colon which causes pouches to protrude outwards.
What is diverticula’s disease?
Formation of outpockets on the walls of the intestine which become inflamed due to infection or autoimmunity.
What are haemorrhoids?
Renal veins form a venous plexus which is divided into
Internal haemorrhoid: above the pectinate line, which are typically painless and accompanied with mucous discharge
External haemorrhoid: below the pectinate line, which are painful especially on defaecation and blood clots can form. These haemorrhoids are palpable.
What causes haemorrhoid formation?
Increase in abdominal pressure from:
Weightlifting
Pregnancy
Obesity
Severe constipation
How does an acute upper GI bleed present?
Haematemesis
Maleana
Shock
Post-rectal bleed
How is an upper GI bleeding managed?
Resuscitation by:
Clearing blood from the pharynx
IV access to provide fluids
Prepare blood to replenish loss
Which patients are at risk of an upper GI bleed?
Elderly people over 65 years old
Co-morbidity with ischaemic heart disease
Low BP and high pulse rate
What is the Rockall scoring system?
Used to assess the severity of a GI bleed prior to endoscopy based on:
Age
Shock
Comorbidities
Which co-morbidities increase the risk of upper GI bleed?
Renal failure
Liver failure
Malignancy
What is obscure GI bleeding?
Bleeding with no detectable source, which commonly occurs in the small bowel.
What is the cause of obscure GI bleeding in under 40’s?
IBD
Lymphoma
Adenocarcinoma
Diverticulum
What is the cause of GI bleeding in over 40’s?
Ulcers
Vascular lesions
Tumours
How is a GI bleed treated?
Identify the source of active bleeding such as a clot or visible vessel
Provide therapeutic endoscopy within 24hrs of admission
Injection of adrenaline to reduce flow
Provide PPI prescription for ulcers
What does colonoscopy indicate?
Cause of bleed
Prognosis
Provision of endoscopic therapy
What does angiography indicate?
Need for angiographic intervention
CT/MRI angiography or femoral angiography
How does a chronic GI bleed present?
Anaemia, accompanied by fatigue,shortness of breath and pallor.
Positive foecal occult blood test
What is a foecal occult blood test? (FOB)
Screening diagnostic test to identify blood that is not visible in stools.
Which medication causes GI bleeding?
NSAIDs
Anti-coagulants
Anti-platelets
What is the response of the body to blood loss less than 15%?
Tachycardia
What is the response of the body to GI blood loss between 15-40%?
Postural blood pressure drop
What is the response of the body to GI blood loss over 40%?
Hypotension
How is the urea-creatinine ratio affected in GI bleed?
Increases due to a lower circulating blood volume
What is lower gastrointestinal bleeding?
Bleeding which is distal to the ligament of Treitz, which typically occurs in the colon and rectum.
How does bleeding in the left colon present in faeces?
Fresh bright blood that may be mixed with clots in the stool.
How does bleeding in the right colon present in faeces?
Maleana, with dark red blood mixed with the stools
What is the cause of lower GI bleeds in under 50’s?
Malignancy
Diverticular disease
Ischaemia
What is the cause of lower GI bleeds in over 50’s?
Haemorrhoids
Diverticular disease
