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GI > GI Bleeding > Flashcards

GI Bleeding Flashcards

1
Q

Four risk factors for peptic ulcers

A

NSAIDS

Heliobacter pylori

alcohol excess

systemic illness

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2
Q

Definition of UGI bleeding

A

Bleeding originating proximal to the LIGAMENT OF TREITZ (ie stomach, oesophagus, duodenum)

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3
Q

Definition of LGI bleeding

A

Bleeding originating DISTAL to the LIGAMENT OF TREITZ (ie small bowel and colon)

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4
Q

What would the Urea levels be for a patient with UGI AND LGI bleeding

A

UGI = Elevated Urea

LGI = Normal Urea

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5
Q

Risk Factors for LGI

A

Age

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6
Q

What medication increase the risk of UGI bleeding

A

use of;

NSAIDS

Aspirin

Clopidogrel

Warfarin

Ibuprofen

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7
Q

Sign/Symptoms of UGI bleeding

A

Epigastric pain

Dyspeptic Symptoms

Haematemesis

Coffee ground vomit

Melaena

Elevated Urea

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8
Q

Sign/Symptoms of LGI bleeding

A

Usually, but not always, Hematochezia

Normal Urea

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9
Q

Define Hematochezia

A

Passage of fresh or altered blood per rectum – may be from upper GI cause as “fast transit” or lower GI

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10
Q

Causes of UGI bleeding

A

Peptic Ulcers

Gastritis/Erosions

Oesophagitis

Erosive Duodenitis

Varices

Portal Hypertensive Gastropathy

Malignancy

Mallory Weiss Tear

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11
Q

Causes of LGI bleeding

A

Diverticular disease

Vascular malformations (angiodysplasia)

Haemorrhoids

Neoplasia (carcinoma or polyps)

Inflammatory bowel disease (eg. ulcerative proctitis, Crohn’s disease)

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12
Q

What is the Rockall Score

A

Simple and widely validated scoring system

Principally designed to predict death

May also be used to estimate rebleeding risk

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13
Q

What is the Blatchford Score

A

Assesses the likelihood that a patient with an acute upper gastrointestinal bleed (UGIB) will need to have medical intervention, such as a blood transfusion or endoscopic intervention

(more accurate than Rockall)

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14
Q

What criteria are assessed in the Rockall Score

A

Age

Shock

Co-morbidities

Diagnosis

Major stigmata of recent haemorrhage

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15
Q

Management of Peptic Ulcers

A

RESUSCITATION

Endoscopy

Endotherapy

PPI’s

Check Helicobacter Pylori status

Discontinue causative/contributory medications

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16
Q

Management of UGI Bleeding

A

Resuscitatin/Identification of shock

Consider blood transfusion +/- platelets/FFP

UGI endoscopy once stable

Endotherapy

Embolisation or surgery if not possible to control endoscopically

17
Q

Forrest Classification of Ulcers

A

/Classificatiion/ Description/
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1 / Actively bleeding ulcer (80%)
a / Spurting
b / Oozing
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2 / Non-actively bleeding ulcer
a / Non-bleeding visible vessel (45%)
b / Adherent Clot (35%)
c / Ulcer with red or blue dark spots
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3 / Ulcer with a clean base

18
Q

Management of Variceal bleeding

A

Endotherapy

19
Q

Types of endotherapy available for Variceal Bleeding

A

Oesophageal = Band Ligation or Glue Injection

Gastric = Glue Injection

Rectal = Glue Injection

20
Q

Management of UNCONTROLLED Variceal Bleeding

A

Sengstaken-Blakemore tube -Tamponade to OG junction (Temporary measure)

Transjugular Intrahepatic Portal Shunt (TIPS)

21
Q

Management of UNCONTROLLED Variceal Bleeding

A

Sengstaken-Blakemore tube -Tamponade to OG junction (Temporary measure)

Transjugular Intrahepatic Portal Shunt (TIPS)

22
Q

Management of LGI bleeding

A

Colonoscopic haemostatic techniques (adrenaline injections, bipolar coagulation or endoscopic hemoclipping)

Angiography and Embolisation

Band ligation for Haemorrhoids

Surgery - Segmental intestinal resection or subtotal colectomy.

23
Q

Sings of shock

A

Tachypnoea

Tachycardia

Anxiety or Confusion

Cool clammy skin

Low urine output (Oliguria)

Hypotension

24
Q

How is shock Classified

A

4 stages (1-4 with 4 being most severe)

Volume lost

% Blood loss

RR

HR

BP

Pulse Pressure

Conscious level

Urine Output

25
Q

Management of Shock

A

A - Airway

B - Breathing

C - Circulation
Wide bored IV access => IV fluids, blood transfusion
Urgent blood samples to lab: FBC, UE, LFT, Coagulation, blood group and save/ cross match
Blood transfusion if Hb<80 or ongoing active bleeding
Evidence that transfusing Hb>100 has worse outcomes

Catheter

D - Disabiltiy

E - Exposure

26
Q

What criteria is assessed in the Blatchford score

A

Haemoglobin

Urea

Pulse (>100)
BP

Presents with Syncope or Melaena

Hepatic Disease

Heart failure

GI (9 decks)

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