GI Bleeds Flashcards
What is the most common site of bleeding from the coeliac trunk?
Stomach and duodenum
The coeliac trunk supplies the foregut, which includes the stomach and duodenum.
What is considered acute upper GI hemorrhage?
Acute bleeding from oesophagus, stomach, or duodenum
What risk factors increase the likelihood of upper GI bleeding?
- Older age
- Drugs (aspirin, NSAIDs, Warfarin)
- Liver disease
- H. pylori
What are the typical presentations of upper GI bleeding?
- Haematemesis
- Coffee ground vomit
- Melaena
- Haemodynamic instability
- Bright red per rectum
- Collapse/anaemia
- Abdominal pain
Coffee ground vomit = type of haematemesis where you have digested blood.
What does melaena indicate?
Upper GI bleed
Digested blood in stool
What causes oesophagitis?
Acid in stomach passing lower oesophageal sphincter leading to erosion
What is a Mallory-Weiss tear?
- Tear caused by repeated vomiting leading to small bleeding
- Small to moderate volume of bright red blood
- Usually ceases spontaneously.
What are oesophageal varices and their risks?
- Enlarged veins in the oesophagus caused by portal hypertension from Liver diseases
- Large volume of fresh blood.
- Swallowed blood may cause melena.
- Haemodynamic compromise.
- Re-bleeds comon
They can lead to rapid bleeding if they burst.
Management of oesophageal varicies
- Prophylactic ABX
- Terlipressin IV
- Endoscopy (Band/balloon ligation)
- Post OGD: PPI
What are the FIRST management steps for upper GI bleeding?
- A-E assessment
- Stabilise Patient
- Scoring systems for predicting re-bleeding and mortality
What score are used to assess risk in Acute GI bleeds?
1) Glasgow-Blatchford Score
2) Rockall Score
What is the Glasgow-Blatchford Score used for?
To assess risk of re-bleeding or mortality before endoscopy
Used to decide if patient can be managed in outpatients
What score using the Glasgow blackford socre indicates patient can be managed as outpatient?
0
How ia patient resusitated in acute GI bleed management?
1) A-E w/ 2xwide-bore IV
2) Platelet transfusion if actively bleeding platelet count of less than 50 x 10^9/litre
3) Fresh frozen plasma
Managment depends on patient presentation.
When should patients have an endoscopy for an acute GI bleed
1) Immediately after resuscitation in patients with a severe bleed
2) all patients should have endoscopy within 24 hours.
What in the hx suggests a GI bleed is associated with stomach cancer?
- Weight loss
- Epigastric pain
- Treatment-resistant dyspepsia
- Anaemia
- Raised platelet count
What are the signs of haemodynamic instability in upper GI bleeding?
- Low BP
- Tachycardia
- Signs of shock
What is the purpose of giving IV fluids in upper GI bleeding management?
To maintain blood pressure and hydration
What is a crucial step in the management of upper GI bleeding after one hour?
Re-assess BP, urine output, and Hb
What should be done if the cause of bleeding is varices before OGD?
Administer antibiotics and IV Terlipressin before endoscopy
What is often bleeding in peptic ulcer disease?
- Often not the ulcer as this will be small amount of haematemesis and not ACUTE.
- In duodenal ulcer the gastroduodenal artery may be eroded causes acute bleeds
What is the Rockall Score?
Rockall score is used after endoscopy
Provides a percentage risk of rebleeding and mortality
includes age, features of shock, co-morbidities, aetiology of bleeding and endoscopic stigmata of recent haemorrhage
