GI Bleeding Flashcards
How do we manage an acute GI bleed presentation?
ABC, protect the airway, IV access with large bore cannulas. Fluids.
What is the 100 rule for poor prognostic group in a GI bleed?
What others are also included in this group?
Systolic under 100
Pulse over 100
HB under 100g/L
Aged over 60
Comorbid disease
Postural hypotension.
What is the blatchford score?
Is used to assess GI bleed patients status. Uses BP, Hb, urea etc.
What is stigmata of recent haemorrhage?
Active bleeding or oozing or an overlying clot or visible vessel.
What are the endoscopic treatments of peptic ulcers?
Injection, heater probe coagulation, clips and haemospray.
Can be given 1:10000 adrenaline to cessation bleeding during the procedure.
How does haemospray work?
When comes into contact with blood, the powder absorbs water, which forms a barrier over the bleeding site.
What are risk factors for bleeding oesophageal varices?
Portal pressure of over 12mmHg
Varices extending over 25% into the lumen.
Presence of red signs
The degree of liver failure.
When should we suspect varices in a bleeder?
Known history of varices or cirrhosis.
History: chronic alcohol excess, chronic viral hepatitis infection, metabolic or autoimmune liver disease.
On examination: stigmata of chronic liver diseases such as spider naevi, ascites, jaundice, palmar erythema leukonychia and encephalopathy.
How is haemostasis achieved in bleeding varices?
Terlipressin (vasopressin analogue) Endoscopic variceal ligation. Sclerotherapy Sengstaken-blakemore tube TIPS procedure.
What does terlipressin do?
Predominantly splanchnic vasoconstriction and has a beneficial effect on renal perfusion.
Superior to vasopressin and somatostatin.
What veins cause oesophageal varices?
The periesophageal venous plexus.
What is a TIPS procedure?
What is it used for?
Burrow through the liver to place a shunt between the portal vein and one of the hepatic veins to try and reduce portal pressure.
Known cirrhosis liver with uncontrollable bleeding oesophageal varices.
What are the causes of GI bleeding from the most to least common?
Duodenal ulcer Gastric erosions Gastric ulcer Varies Malory Weiss tear Oesophagitis Etc.
