GI Bleeding Flashcards
aetiology of GI bleeding
most common - duodenal ulcer, gastric erosions and gastric ulcers
how is the severity of a GI bleed assessed
Rockall Risk Scoring System
blatchford score
risks for GI bleeds
beta-blockers
diabetes - poor autonomic response
tests for GI bleeding
gastroscopy (OGD)
describe the rockall risk scoring system
the 10 rule; systolic BP > 100 HR >100 BPM Hb <100 age>60 comorbid disease postural drop in BP
treatment for low risk GI bleed
discharge without OGD
review causative drugs
treatment for indeterminate risk GI bleed
monitor Hb
significant bleeding - IV omeprazole (PPI)
cirrhosis/liver disease - terlipressin
NEWS score
reverse coagulopathy
reassess in 12-24 hours to determine if OGD required
discuss with senior care
treatment for high risk GI bleed
repeat Hb levels - determine blood loss and if transfusion required
significant bleeding - IV omeprazole (PPI)
cirrhosis/liver disease - terlipressin
NEWS score
reverse coagulopathy
OGD immediately
discuss with senior care immediately
describe the stigmata of recent haemorrhage
active bleeding
overlying clot
visible vessel
treatment of bleeding peptic ulcers
endoscopic treatment
acid suppression
surgery
H.pylori eradication (if appropriate)
bleeding continues - surgery
describe endoscopic treatment of peptic ulcers
injeciton heater probe coagulation combination clips haemospray
how does haemospray work
comes into contact with blood - powder absorbs water and acts both cohesively and adhesively
mechanical barrier formed over bleeding site
describe acid suppression treatment
IV omeprazole
risk factors of acute variceal bleeding
portal pressure >12 mmHg
varices > 25% oesophageal lumen
presence of alarm signs
liver failure
history of cirrhosis with varies
complications of acute variceal bleeding
sepsis
liver failure
describe history of cirrhosis with varices
chronic alcohol excess
chronic viral hepatitis infection
metabolic or autoimmune liver disease
intra-abdominal sepsis/surgery
signs of acute variceal bleeding
spider naevi palmar erythema leukonychia encephalopathy ascites jaundice
initial management of acute variceal bleeding
resuscitation antibiotics terlipressin early OGD Endoscopic variceal ligation
how is haemostasis achieved in acute variceal bleeding
teripressin (vasopressin) endoscopic variceal ligation (banding) sclerotherapy sengstaken-blakemore tube balloon TIPS
describe teripressin
vasopressin produg
predominantly splanchnic vasoconstrictor
beneficial effect on renal perfusion
when would sengstaken-blakemore tube be used in treatment of acute variceal bleeding
failure of endoscopic haemostasis
delay until endoscopy
treatment of acute variceal bleed after bleeding has stopped after initial management
propranolol
banding programme
treatment of acute variceal bleed after bleeding has NOT stopped after initial management
Endoscopic variceal ligation or S-B tube
Transjugular intrahepatic portosystemic shunt
hepatic function;
good - observe
poor - transplant
