GI bleeding Flashcards
melaena =
passage of black tarry stools -distinctive smell
where does the bleeding occur to form melaena
proximal to the right colon
most common cause of GI bleeding
peptic ulcer
2 locations of peptic ulcer
duodenal
gastric
ulcer=
inflammation that can extend to whole length of gastric wall
mucosa contains
- non-ciliated simple columnar
- basement membrane
- lamina propria
symptoms of peptic ulcers
dyspepsia
epigastric pain
N&V
chest pain
with a peptic ulcer when is epigastric pain worse
eating
when is epigastric pain better
lying flat and antacids
what type of bacteria is H.pylori
gram negative
what does H.pylori do to stomach
causes inflammation disrupting mucosa production
Zollinger-ellison syndrome=
tumours in pancreas which causes overproduction of gastric acid
risk factors for peptic ulcer
smoking age family history blood group A NSAID use
gastritis symptoms=
dyspepsia epigastric pain anorexia bloating N&V
gastritis=
inflammation in stomach lining with no ulcer present
most common cause of gastritis=
H.pylori infection
mallory-weiss tear=
bleeding from a longitudinal laceration in mucosa and submucosa at junction between oesophagus and stomach
presentation of mallory-weiss tear
haematemesis
abdominal pain
involuntary retching
melena
chronic history of what for mallory-weiss tear
alcoholism and bulimia
oesophagitis presentation =
dysphagia impaction of food heart burn N&V abdo pain
what is oesophagitis highly associated with
hiatus hernias
2 types of hernias
sliding hernias
rolling hernias
sliding hernia=
gastro-oesophageal junction slides into chest
rolling hernia=
bulge of the stomach herniates alongside oesophagus gastro-oesophageal junction remains still
in younger patients what is the most common type of oesophagitis
eosinophilic
what is eosinophilic oesophagitis
TH2 allergic response eosinophilic infiltration into the mucosa
gastro-oesophageal cancer presentation (6)
anorexia weight loss N&V dysphagia regurgitation hoarseness and cough
2 forms of gastro-oesophageal cancer
squamous cell
adenocarcinoma
oesophageal cancer more common in developing world -associated with poor diet upper 2/3
squamous cell
adenocarcinoma found in which part of oesophagus
lower 1/3
main association with adenocarcinoma of oesophagus
Barrett’s oesophagus
what happens in Barretts oesophagus
squamous cell metaplasia into simple columnar with goblet cells
oesophageal varices=
extremely inflamed submucosal veins in lower third of oesophagus
presenting of oesophageal varices
haematemesis
melena
hematochezia
jaundice
why are veins dilated in oesophageal varices
congestion of blood from increased portal hypertension
causes of portal hypertension (3)
cirrhosis
hepatitis
alcoholism
features of liver disease (6)
jaundice parotitis spider naevi palmar erythema hepatosplenomegaly ascites
3 consequences of portal HTN
encephalopathy
splenomegaly
peripheral oedema
treatment of oesophageal varices
ABCDE
therapeutic endoscopy
therapeutic endoscopy for varices
variceal ligation
banding or sclerotherapy
sclerotherapy=
adrenaline and thrombin
medications that can increase susceptibility to GI bleed (6)
warfarin prednisolone NSAIDs SSRIs calcium channel blockers
angiodysplasia=
small vascular malformation of gut
angiodysplasia most common in which area
caecum or ascending colon
development of angiodysplasia because
increased strain on the bowel wall due to chronic intermittent contraction of the colon
treatment of angiodysplasia
blood transfusion and endoscopic treatment
GAVE=
gastric antral vascular ectasia
endoscopy for GI bleeding
- endoscopy offered immediately to unstable patients after resus
- within 24 hrs for everyone else
blood tests for GI bleeds
FBC
platelets
biochemistry
LFTs
why can FBC be normal after a GI bleed
as haemodilution hasn’t occurred yet
why might platelets be low in GI bleeding
hypersplenism due to portal hypertension
why do you get elevated urea relative to Cr in GI bleeds
high protein meal due to blood in GI tract
chronic liver disease effect on hepatic synthesis
low serum albumin
+ coagulopathy
acute assessment of GI bleed (4)
resuscitation
blatchford scale
history
endoscopy
chronic assessment of GI bleed
faecal occult blood FBC stool sample -H.pylori ABGs and ECGs flexible sigmoidoscopy or colonoscopy
2 scales assessing severity of bleed / likelihood of recurrence
blatchford and rockall scores
which scale requires an endoscopy
rockall
2 medications taken for 5 days after variceal upper GI bleed
terlipressin
octerotide
terlipressin=
vasopressin analogue
octreotide=
somatostatin analogue
what do terlipressin and octreotide do
reduce portal hypertension and collateral pressure being applied to oesophageal veins
endoscopic treatment of varices (3)
- band ligation
- sclerotherapy
- injection of N-butyl-cyanoacrylate
therapy to eradicate H.pylori (3)
clarithromycin
amoxicillin
PPI
peptic ulcer management (4)
- endoscopy
- 72 hours PPI infusion +oral treatment after
- stop NSAIDs
- lifestyle education
when is interventional radiology used
when patients GI bleeds remain resistant to medical and endoscopic treatment
internal haemorrhoids present as
painless
bright red bleeding when defecating
external haemorrhoids present as (3)
- pain and swelling in area of anus
- pruritus ani
- feeling inadequate cleaning
ischaemic colitis presentation (5)
abdo pain hematochezia/ melena diarrhoea abdominal bruit cardiovascular shock
what is ischaemic colitis
superior mesenteric arteries supplying colon are occluded due to thromboembolic events
what area of the colon is most affected in ischaemic colitis and why
splenic flexure -least collateral blood supply
diverticulosis presentation (5)
- LQ abdominal pain, guarding and tenderness
- fever
- rectal bleeding
- bloating
- constipation
strong history for diverticulosis=
over 50 with low fibre intake
what can obstruct the bowel in crohn’s
strictures formed by muscular hypertrophy
cramping in Crohn’s is most commonly in the
RLQ
anal fissures presentation
pain on defecation
hematochezia
anal spasm
what are anal fissures a common complication of
Crohn’s
symptoms of right sided colon cancer (5)
- malaise
- weight loss
- vague abdominal pain
- palpable mass in right iliac
- iron deficiency anaemia
which colon cancer presents later
right sided
symptoms of left sided colon cancer
- obstructive symptoms
- colicky pain
- change in bowel habit
- passage of mucus
symptoms of rectal tumours
rectal bleeding
mucus discharge
tenesmus
which colon cancer is more likely to present with increased frequency and looser stools +rectal bleeding
left sided
1mL of blood loss needs
3mL of crystalloid fluid
OGD=
oesophago-gastro-duodenoscopy
3 ulcer grades
type 1, 2 and 3
type 3 ulcer=
clean based lesion with no stigmata of bleeding
type 1 ulcers=
spurting or oozing type 100% probability of re-bleed
type 1 ulcers=
recent bleed thrombosed
50% chance of re-bleed
