gi bleeding Flashcards
what is haematemesis
vomiting of blood
what is melaena
passage of black tarry stools
black is due to blood altered by passage through the gut
what is passage of dark blood and clots without shock due to
lower GI bedding
what is most common cause of serious and life threatening GI bleeding
peptic ulcer
what can cause significant GI bleeding in developing world
viral infections
what are causes of upper GI bleeding
- mallory-weiss syndrome
- gastric ulcer
- duodenal ulcer
- varices
- gastric varices
- gastric carcinoma
what drugs can produce ulcers
- aspirin
- NSAIDs
what scoring is based clinical and endoscopy findings
Rockall score
what scoring is based on plasma urea, haemoglobin and clinical markers
Blatchford score
what is immediate management
stop:
- NSAIDs
- aspirin
- clopidogrel
- warfarin
stopping anti-platelets can. be dangerous and may produce thrombosis
what is done to diagnose
endoscopy
how are varices treated
banding
what else is used for bleeding varices
stenting
treatment for bleeding ulcers
- injection with adrenaline
- endoscopic clipping
- inject thermal coagulation
select 2/3
what should be done
antral biopsies to look for H.pylori
what should be done first for treatment after endoscopy
IV PPI
because it reduces bleeding rates and need for surgery
what is mallory-weiss tear
linear mucosal tear occurring in oesophagogastric junction
what does mallory-weiss tear often follow
bought of coughing or retching
commonly seen after alcoholic ‘dry heaves’
treatment for mallory-weiss tear if any
clipping
surgery with oversewing if tear is really bad but rarely
treatment if patient has chronic peptic ulcer
eradication of H.pylori
what is continued if patient has chronic peptic ulcer and for how long
PPI for 4 weeks to ensure ulcer healing
what is done if bleeding is not under control in patient with peptic ulcer
angiography and embolisation
or
surgery
what is massive bleeding from lower GI tract due to
diverticular disease
or
ischaemic colitis
what are common cause of small bleeds
haemorrhoids
anal fissure
other causes of lower GI bleeds
- angiodysplasia
- carcinoma
- diverticula
- meckel’s diverticulum
- anal fissure
- colitis
- haemorrhoids
- polyps
- ischaemic colitis
do lower GI bleeds usually stop spontaneously
yes
how is diagnosis of lower GI bleed usually done
history and examination (rectal exam)
what investigations are done for lower GI bleeds
- proctoscopy
- flexible sigmoidoscopy
- video capsule endoscopy
- angiography
what is proctoscopy good for
haemorrhoids
what is sigmoidoscopy good for
IBD
cancer
ischaemic colitis
diverticular disease
what do patients with chronic GI bleeding have with it
anaemia
what is primary concern of GI bleeding in adults
cancer
of stomach, right colon
and coeliac disease
what is most common cause of chronic GI blood loss
hookworm
uncommon in developed world
what is usually performed first in chronic GI bleeding
upper GI endoscopy
what should be done during endoscopy for chronic GI bleeding
biopsy
to diagnose coeliac disease
what is done second in chronic GI bleeding
colonoscopy
what is useful diagnosis for colon cancer in frail patients
CT
what is an alternative to colonoscopy
CT colonography
what is diagnostic investigation of choice for upper GI bleeding
capsule endoscopy
what is given to treat anaemia
oral iron