GI bleeding Flashcards
Acute upper GI bleed
Most common GI emergency
What can you tell from looking at heamatemesis
If bright red with clots indicates profuse bleeding
If black (coffee ground) less severe.
What is maleana
It is the passage of black tarry stools (bad smell)
Usually because of upper GI bleed
Sometimes the ascending is involved
Causes of acute upper GI bleed
Peptic Ulcer disease (H.pylori or NSAIDs)
Gastric Erosions (Alcohol or NSAIDs)
Oesophagitis (10%)
Varices
Mallory-weiss tear
Vascular malformations
Carcinoma of stomach or oesophagus
Drugs (NSAIDs, aspirin, thrombolytics, anticoagulants)
Management of Acute upper GI bleed
IV access with a large bore cannula
RAPDD and ABCDE approach
Oxygen
Blood transfusion
Abx
Endoscopy - after resuscitation
Hourly observations
Surgery - if Endoscopic haemotemesis fails
Where could lower bowel bleeds occur
in small bowel,colon ,or anal canal.
Causes of severe acute lower bowel bleeds
Diverticular disease is the most commonest
Angiodysplasia - Vascular malformation in elderly
Ischaemia due to Inferior mesenteric artery occlusion
Meckel’s Diverticulum
Describe the bleeds that occur in Diverticular disease
profuse red or maroon diarrohoea and shock
Bleeding always stops spontaneously, but sometimes dont and angiography or colonoscopy is needed.
Subacute/Chronic Lower GI bleeding
Extremely common and usually caused by haemorrhoids or anal fissure
What is Proctoscopy
device used to investigate anal, sigmoid colon or rectal cavity
What is laparotomy
open abdo surgery - midline scar
Oscure major GI bleeding
When source is unkown a Laparotomy may be needed
Occult GI bleeding
When there is non visible bleeding
Which causes iron deficieny anaemia
Most important cause is colorectal cancer which can present with no GI symptoms
Anyone with iron deficiency anaemia should be investigated for malignancy
What to ask about with a patient of Hx GI bleed
Past GI bleeds
Dyspepsia
Dysphagia
Vomiting
Weight loss
Peptic Ulcer
Liver disease
Oesophageal varices
Drugs and alcohol
