GI Bleeding Flashcards
Four risk factors for peptic ulcers
NSAIDS
Heliobacter pylori
alcohol excess
systemic illness
Definition of UGI bleeding
Bleeding originating proximal to the LIGAMENT OF TREITZ (ie stomach, oesophagus, duodenum)
Definition of LGI bleeding
Bleeding originating DISTAL to the LIGAMENT OF TREITZ (ie small bowel and colon)
What would the Urea levels be for a patient with UGI AND LGI bleeding
UGI = Elevated Urea
LGI = Normal Urea
Risk Factors for LGI
Age
What medication increase the risk of UGI bleeding
use of;
NSAIDS
Aspirin
Clopidogrel
Warfarin
Ibuprofen
Sign/Symptoms of UGI bleeding
Epigastric pain
Dyspeptic Symptoms
Haematemesis
Coffee ground vomit
Melaena
Elevated Urea
Sign/Symptoms of LGI bleeding
Usually, but not always, Hematochezia
Normal Urea
Define Hematochezia
Passage of fresh or altered blood per rectum – may be from upper GI cause as “fast transit” or lower GI
Causes of UGI bleeding
Peptic Ulcers
Gastritis/Erosions
Oesophagitis
Erosive Duodenitis
Varices
Portal Hypertensive Gastropathy
Malignancy
Mallory Weiss Tear
Causes of LGI bleeding
Diverticular disease
Vascular malformations (angiodysplasia)
Haemorrhoids
Neoplasia (carcinoma or polyps)
Inflammatory bowel disease (eg. ulcerative proctitis, Crohn’s disease)
What is the Rockall Score
Simple and widely validated scoring system
Principally designed to predict death
May also be used to estimate rebleeding risk
What is the Blatchford Score
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)
What criteria are assessed in the Rockall Score
Age
Shock
Co-morbidities
Diagnosis
Major stigmata of recent haemorrhage
Management of Peptic Ulcers
RESUSCITATION
Endoscopy
Endotherapy
PPI’s
Check Helicobacter Pylori status
Discontinue causative/contributory medications
Management of UGI Bleeding
Resuscitatin/Identification of shock
Consider blood transfusion +/- platelets/FFP
UGI endoscopy once stable
Endotherapy
Embolisation or surgery if not possible to control endoscopically
Forrest Classification of Ulcers
/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
Management of Variceal bleeding
Endotherapy
Types of endotherapy available for Variceal Bleeding
Oesophageal = Band Ligation or Glue Injection
Gastric = Glue Injection
Rectal = Glue Injection
Management of UNCONTROLLED Variceal Bleeding
Sengstaken-Blakemore tube -Tamponade to OG junction (Temporary measure)
Transjugular Intrahepatic Portal Shunt (TIPS)
Management of UNCONTROLLED Variceal Bleeding
Sengstaken-Blakemore tube -Tamponade to OG junction (Temporary measure)
Transjugular Intrahepatic Portal Shunt (TIPS)
Management of LGI bleeding
Colonoscopic haemostatic techniques (adrenaline injections, bipolar coagulation or endoscopic hemoclipping)
Angiography and Embolisation
Band ligation for Haemorrhoids
Surgery - Segmental intestinal resection or subtotal colectomy.
Sings of shock
Tachypnoea
Tachycardia
Anxiety or Confusion
Cool clammy skin
Low urine output (Oliguria)
Hypotension
How is shock Classified
4 stages (1-4 with 4 being most severe)
Volume lost
% Blood loss
RR
HR
BP
Pulse Pressure
Conscious level
Urine Output
Management of Shock
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
What criteria is assessed in the Blatchford score
Haemoglobin
Urea
Pulse (>100)
BP
Presents with Syncope or Melaena
Hepatic Disease
Heart failure
