GI Bleeding

Question 1

List all the causes of GI bleeding.

Start from the top of the GI tract and work down.

Answer 1

Question 2

What are the causes of upper GI bleeds? (Most common - least common)

Answer 2

• Peptic ulcer
• Gastritis
• Oesophagitis
• Varices
• Mallory-Weiss tear
• Vascular malformation
• Malignancy
• Aorto-duodenal fistula

Question 3

What are the causes of lower GI bleeds? (Most common - least common)

Answer 3

• Diverticulosis + anorectal
• IBD (Crohn’s / UC)
• Coagulopathy
• Angiodysplasia
• Unknown

Question 4

Describe the presentation of a lower GI vs an upper GI bleed.

Answer 4

• Upper GI bleed
  
  • ​Iron deficiency anaemia
  • Malaena
  • Haematemesis + / - malaena
  • Coffee ground vomiting
  • FOB+
• Lower GI bleed
  
  • ​Iron deficiency anaemia
  • Malaena
  • Blood mixed with stools
  • PR bleeding (Gush in pan)
  • Bright blood on toilet paper
  • FOB+

Question 5

Describe the assessment of a patient who is having a GI bleed.

Answer 5

• Airway
• Breathing
• Circulation
  
  • ​BP, HR (level of shock)
• Current Hx
• Past Hx
• Medication Hx
  
  • If they have a hx of taking NSAIDs the last couple of weeks for new pain and they suddenly have black stools you know straight away.
• FHx?

Question 6

Which scoring systems would you use for a patient having an upper GI bleed?

Answer 6

• Glasgow-Blachford score
• Rockhall score

Question 7

How would you manage a patient having an upper or lower GI bleed?

Answer 7

• RESUSCITATION (if massive bleeding)
• ABC​ (if massive bleeding)
• O₂
• Venflon (haematology / biochemistry / clotting)
• Fluids + PPI + correct clotting abnormalities
• Major haemorrhage protocol (if massive bleeding)
• Investigation and treatment
  
  • If they are stable - investigtion first and treatment after.
  • If major haemorrhage - follow the protocol.

Question 8

How would you investigate an upper GI bleed?

Answer 8

• Oesophago-gastro-duodenoscopy (OGD)
• CT mesenteric angiogram

Question 9

How would you investigate a lower GI bleed?

Answer 9

• Oesophago-gastro-duodenoscopy (OGD) + colonoscopy
• Colonoscopy (no role in an acute bleed)
• CT mesenteric angiogram
• Formal angiogram + embolisation

Question 10

What treatments for upper GI bleeding can be carried out during Oesophago-gastro-duodenoscopy (OGD)?

Answer 10

• Varices
  
  • ​Band ligation
  • Stenting
  • TIPS (transjugular intrahepatic portosystemic shunt)
  • Injection N-butyl-2-cyanoacrylate
• Ulcers
  
  • ​Clips
  • Thermal coagulation + adrenaline
  • Thermal coagulation + Fibrin
• Varices and ulcers are unstable with a re-bleed - consider CT mesenteric angiogram +/- embolisation.

Question 11

What is this colonoscopy finding?

Answer 11

Polyp

Question 12

What is this colonoscopy finding?

Answer 12

Inflammatory bowel disease

Question 13

What is this colonoscopy finding?

Answer 13

Colon cancer