GI Bleeding Flashcards
What is the most common causes of GI bleeding?
DU ulcer
GU ulcer
Varices
Mallory-Weiss tear
How would you assess the severity of the haemorrhage?
The 100 rule
Systolic BP < 100mmHg Pulse > 100 Hb < 100g/l Age > 60 Cormorbid disease Postural drop in BP
How would you treat a patient with GI bleeding?
RESUSCITATE
Airway protection
Oxygen
IV fluids - wide bore cannula
What investigation might you do and why?
Endoscopy - identify the cause, therapeutic manoeuvres, assess rick of re-bleeding
What is the Rockall risk score for GI bleeding?
A scoring system to assess the severity of bleeding
What other scoring system might you do instead of the Rockall risk score?
The blatchford score
What might you see that would be suggestive of recent haemorrhage?
Active bleeding/ozzing
Overlying clot
Visible vessel
What might be the treatments given for a bleeding peptic ulcer?
Endoscopy treatment (high risk ulcers) Acid suppression (infusions) - omeprazole Surgery
H.Pylori eradication - secondary prevention
What different endoscopic treatments of peptic ulcers are there?
Injection - adrenaline Heater probe coagulation Combinations Clips Haemospray - causes mechanical barrier over the bleeding site
What would you do if you treated a pt with peptic ulcers with adrenaline injection/heater probe etc and the bleeding didn’t stop?
Take straight to surgery
What would you do if the patient after having initial management to stop the bleeding had a re bleed?
Give omeprzole and try again for endoscopic therapy
if didn’t work take to surgery
What should you do if you have a patient who has successful peptic ulcer bleeding stop?
Give omeprazole
H.Pyloric eradication as appropriate and course of oral PPI
What are the risk factors for Acute Vatical Bleeding?
Portal pressure > 12mmHg
Caricies
presence of red signs
degree of liver failure
What do the majority of patients with varices have?
Chronic liver failure
What things in a history might suggest varices in a patient?
chronic alcohol excess
chronic viral hepatitis infection
metabolic or autoimmune liver disease
intra-abdominal sepsis/surgery
What are the aims of management?
Resusciation Haemostasis Prevent complications of bleeding Prevent deterioration of liver function Prevent early re-bleeding
What should your initial considerations be in a GI bleed?
coagulopathy (FFP/platelets/vitamin K) CVP monitoring (portal pressure vs CVP) parenteral vitamins antibiotics (Goulis et al, 1999, Bernard et al, 1999) unexpected pathology e.g. perforated D.U. hypoglycaemia replace K+, Mg2+ and PO42- delirium tremens (perhaps later)
How can you achieve haemostasis?
Terlipressin (vasopressin analogue) Endoscopic variceal ligation (banding) (Sclerotherapy) Sengstaken-Blakemore balloon TIPS
Describe more about Terlipressin?
Vasopressin prodrug
Predominantly splanchnic vasoconstrictor
Beneficial effect on real perfusion
Superior to vasopressin, somatostatin etc
Describe banding?
You just band the varices
What is TIPS?
Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that may be used to reduce portal hypertension and its complications, especially variceal bleeding. A TIPS procedure may be done by a radiologist, who places a small wire-mesh coil (stent) into a liver vein.
