GI Bleeding

Question 1

GI bleeding must be considered as a …

Answer 1

medical emergency until proven otherwise

Question 2

Haematemasis

Answer 2

Vomiting blood

Question 3

Coffee ground appearance

Answer 3

Partially digested blood

Question 4

Melena

Answer 4

dark sticky faeces with partially digested blood

Question 5

What is GI bleeding death usually caused by

Answer 5

complications rather than exsanguination

Question 6

Most common cause of GI bleeding

Answer 6

Duodenal ulcer

Question 7

Resuscitation involves

Answer 7

A - airway protection
B - breathing (oxygen)
C - circulation (fluids)

Question 8

Using the 100 Rule to assess severity includes

Answer 8

B.P systolic <100mmHg
Pulse > 100/ min
Hb <100g/l
Age > 60
Comorbid disease
Postural drop in blood pressure

Question 9

What is an OGD

Answer 9

Oesophageo - gastro - duodenoscopy

Question 10

What is an OGD used for

Answer 10

Identity cause
Therapeutic manoeuvres
Assess risk of bleeding

Question 11

Endoscopic Treatments of a bleeding peptic ulcer

Answer 11

Injection
Heat probes
Combinations
Clips
Haemospray

Question 12

How does haemospray work

Answer 12

Absorbs water and forms a mechanical barrier over the bleeding

Question 13

Peptic ulcer disease management pathway if bleeding stops

Answer 13

Peptic ulcer at endoscopy

Adrenaline / heater probe/ thermocoagulation/ clips

Bleeding stops
- IV omeprazole

• H. pylori treatment as appropriate and oral PPI course

Question 14

Peptic ulcer management if bleeding doesn’t stop

Answer 14

Adrenaline/ thermo coagulation/ heat probe/ clips

Re- bleed after initial haemostatsis

Omeprazole Iv

Further attempt at endoscopic treatment

If bleeding continues

IR or surgery

Question 15

Variceal bleeding complications usually due to

Answer 15

Liver failure

Sepsis

Question 16

risk factors for variceal bleeding

Answer 16

Portal pressure >12 mmHg
varices > 25% oesophageal lumen
presence of red flags
liver failure

Question 17

when to suspect oesophageal varicies

Answer 17

Chronic alcohol excess
Chronic viral hepatitis
Metabolic or autoimmune liver disease
Intra - abdominal sepsis/ surgery

Stigmata of chronic liver disease

Question 18

Stigmata of chronic liver disease

Answer 18

Spider naevi
Ascites
palmar erythema
enteropathy
jaundice

Question 19

Aims of variceal bleeding management

Answer 19

Resuscitation
haemostasis
prevent complications of bleeding
Prevent deterioration of liver function
Prevent early re- bleeding

Question 20

How is haemostasis achieved

Answer 20

Terlipressin
Endoscopic variceal ligation
Sclerotherapy
TIPS
Sengastaken- Blakemore balloon

Question 21

What kind of drug is Terlipressin

Answer 21

Vasoconstrictor

Beneficial effect on renal perfusion

Question 22

When is TIPS used

Answer 22

known cirrhotic with uncontrolled variceal bleeding

Question 23

What does TIPS allows

Answer 23

Blood travels directly from the hepatic vein into the portal vein bypassing the liver

Question 24

Management of a variceal bleed first line

Answer 24

resuscitation, antibiotics, terlipressin + early OGD + EVL

Question 25

Management of variceal bleeding if it stops

Answer 25

Propanolol + banding programme

Question 26

Management of variceal ligation if bleeding sontinues

Answer 26

EVL/ SB tube

Bleeding continues

TIPPS

• Good hepatic function - observe
• Poor hepatic function transplant?