GI Bleeding Flashcards
GI bleeding must be considered as a …
medical emergency until proven otherwise
Haematemasis
Vomiting blood
Coffee ground appearance
Partially digested blood
Melena
dark sticky faeces with partially digested blood
What is GI bleeding death usually caused by
complications rather than exsanguination
Most common cause of GI bleeding
Duodenal ulcer
Resuscitation involves
A - airway protection
B - breathing (oxygen)
C - circulation (fluids)
Using the 100 Rule to assess severity includes
B.P systolic <100mmHg Pulse > 100/ min Hb <100g/l Age > 60 Comorbid disease Postural drop in blood pressure
What is an OGD
Oesophageo - gastro - duodenoscopy
What is an OGD used for
Identity cause
Therapeutic manoeuvres
Assess risk of bleeding
Endoscopic Treatments of a bleeding peptic ulcer
Injection Heat probes Combinations Clips Haemospray
How does haemospray work
Absorbs water and forms a mechanical barrier over the bleeding
Peptic ulcer disease management pathway if bleeding stops
Peptic ulcer at endoscopy
Adrenaline / heater probe/ thermocoagulation/ clips
Bleeding stops
- IV omeprazole
- H. pylori treatment as appropriate and oral PPI course
Peptic ulcer management if bleeding doesn’t stop
Adrenaline/ thermo coagulation/ heat probe/ clips
Re- bleed after initial haemostatsis
Omeprazole Iv
Further attempt at endoscopic treatment
If bleeding continues
IR or surgery
Variceal bleeding complications usually due to
Liver failure
Sepsis
risk factors for variceal bleeding
Portal pressure >12 mmHg
varices > 25% oesophageal lumen
presence of red flags
liver failure
when to suspect oesophageal varicies
Chronic alcohol excess
Chronic viral hepatitis
Metabolic or autoimmune liver disease
Intra - abdominal sepsis/ surgery
Stigmata of chronic liver disease
Stigmata of chronic liver disease
Spider naevi Ascites palmar erythema enteropathy jaundice
Aims of variceal bleeding management
Resuscitation haemostasis prevent complications of bleeding Prevent deterioration of liver function Prevent early re- bleeding
How is haemostasis achieved
Terlipressin Endoscopic variceal ligation Sclerotherapy TIPS Sengastaken- Blakemore balloon
What kind of drug is Terlipressin
Vasoconstrictor
Beneficial effect on renal perfusion
When is TIPS used
known cirrhotic with uncontrolled variceal bleeding
What does TIPS allows
Blood travels directly from the hepatic vein into the portal vein bypassing the liver
Management of a variceal bleed first line
resuscitation, antibiotics, terlipressin + early OGD + EVL
Management of variceal bleeding if it stops
Propanolol + banding programme
Management of variceal ligation if bleeding sontinues
EVL/ SB tube
Bleeding continues
TIPPS
- Good hepatic function - observe
- Poor hepatic function transplant?
