GI Bleeding

Question 1

aetiology of GI bleeding

Answer 1

most common - duodenal ulcer, gastric erosions and gastric ulcers

Question 2

how is the severity of a GI bleed assessed

Answer 2

Rockall Risk Scoring System

blatchford score

Question 3

risks for GI bleeds

Answer 3

beta-blockers

diabetes - poor autonomic response

Question 4

tests for GI bleeding

Answer 4

gastroscopy (OGD)

Question 5

describe the rockall risk scoring system

Answer 5

the 10 rule;
systolic BP > 100
HR >100 BPM
Hb <100
age>60
comorbid disease
postural drop in BP

Question 6

treatment for low risk GI bleed

Answer 6

discharge without OGD

review causative drugs

Question 7

treatment for indeterminate risk GI bleed

Answer 7

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

Question 8

treatment for high risk GI bleed

Answer 8

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

Question 9

describe the stigmata of recent haemorrhage

Answer 9

active bleeding
overlying clot
visible vessel

Question 10

treatment of bleeding peptic ulcers

Answer 10

endoscopic treatment
acid suppression
surgery
H.pylori eradication (if appropriate)

bleeding continues - surgery

Question 11

describe endoscopic treatment of peptic ulcers

Answer 11

injeciton
heater probe coagulation 
combination 
clips
haemospray

Question 12

how does haemospray work

Answer 12

comes into contact with blood - powder absorbs water and acts both cohesively and adhesively
mechanical barrier formed over bleeding site

Question 13

describe acid suppression treatment

Answer 13

IV omeprazole

Question 14

risk factors of acute variceal bleeding

Answer 14

portal pressure >12 mmHg
varices > 25% oesophageal lumen
presence of alarm signs
liver failure

history of cirrhosis with varies

Question 15

complications of acute variceal bleeding

Answer 15

sepsis

liver failure

Question 16

describe history of cirrhosis with varices

Answer 16

chronic alcohol excess
chronic viral hepatitis infection
metabolic or autoimmune liver disease
intra-abdominal sepsis/surgery

Question 17

signs of acute variceal bleeding

Answer 17

spider naevi
palmar erythema
leukonychia 
encephalopathy
ascites
jaundice

Question 18

initial management of acute variceal bleeding

Answer 18

resuscitation 
antibiotics 
terlipressin 
early OGD
Endoscopic variceal ligation

Question 19

how is haemostasis achieved in acute variceal bleeding

Answer 19

teripressin (vasopressin)
endoscopic variceal ligation (banding)
sclerotherapy
sengstaken-blakemore tube balloon
TIPS

Question 20

describe teripressin

Answer 20

vasopressin produg
predominantly splanchnic vasoconstrictor
beneficial effect on renal perfusion

Question 21

when would sengstaken-blakemore tube be used in treatment of acute variceal bleeding

Answer 21

failure of endoscopic haemostasis

delay until endoscopy

Question 22

treatment of acute variceal bleed after bleeding has stopped after initial management

Answer 22

propranolol

banding programme

Question 23

treatment of acute variceal bleed after bleeding has NOT stopped after initial management

Answer 23

Endoscopic variceal ligation or S-B tube
Transjugular intrahepatic portosystemic shunt
hepatic function;
good - observe
poor - transplant