GI Bleeding

Question 1

Haematemesis

Answer 1

Vomiting blood

Question 2

Malaena

Answer 2

Blood in faeces

Question 3

People in poor prognostic group for upper GI bleeding

Answer 3

Systolic BP <100mmHg, pulse >100bpm, Hb <100g/L, age>60, comorbidities, postural drop in blood pressure

Question 4

What does gastroscopy allow you to do in upper GI bleed

Answer 4

Identify cause, therapeutic manoeuvres, assess risk of bleeding

Question 5

Treatment for bleeding peptic ulcers

Answer 5

Endoscopic treatment, acid suppression via IV omeprazole, surgery, eradicate H.pylori

Question 6

Endoscopic treatment for peptic ulcers

Answer 6

Injection (adrenaline), heater probe coagulation, combinations, clips, haemospray

Question 7

How does haemospray work?

Answer 7

When it comes into contact with blood, the powder absorbs water, then acts both cohesively and adhesively, forming a mechanical barrier over the bleeding site

Question 8

Risk factors for acute variceal bleeding

Answer 8

Portal pressure >12mmHg, varices >25% oesophageal lumen, presence of red signs, degree of liver failure

Question 9

When to suspect variceal bleeding

Answer 9

Known history of cirrhosis with varices, chronic alcohol excess, chronic viral hepatitis, metabolic or autoimmune liver disease, intra-abdominal sepsis/surgery

Question 10

How to achieve haemostasis

Answer 10

Terlipressin, endoscopic variceal ligation, sclerotherapy, TIPS, ballooning