GI Bleeds Flashcards
Causes of upper GI bleeds
- peptic ulcer (most common)
- angdysplasia
- Mallory Weiss teat
- Boerhaave syndrome
- oesophageal varices
- gastric or oesophageal cancers
- gastritis or oesophagitis
- dieulafoy lesion
- aortoenteric fistula
Presentation of upper GI bleed
- haematemesis
- coffee grounds vomit
- malaena
- abdominal pain
- haemodynamic instability > tachycardia, hypotension, signs of shock
Why do upper GI bleeds cause coffee ground vomit?
Due to vomiting digested blood
What is melaena?
Tar like black greasy offensive stools due to digested blood
What is a Mallory Weiss tear?
Tear in the oesophageal mucosa
Occurs after heavy vomiting
What is boerhaave syndrome?
Spontaneous rupture of oesophagus
Secondary to severe vomiting episodes
What is a dieulafoy’s lesion?
Dilated arterial vessel that bleeds intermittently
What are aortoenteric fistulas?
Abnormal connection between aorta + GI tract
(Life threatening)
What is Gasglow Blatchford score used for?
- Used in initial presentation in suspected GI bleed
- risk of patient having an upper GI bleed
- calculated before endoscopy
- score >0 suggests bleed
Why do upper GI bleeds cause a raise in blood urea?
Acid + digestive enzymes break down blood in the upper GI tract
One of the breakdown products is urea > absorbed into intestines > increase in blood urea
What is the Rockall score used for?
used after endoscopy to estimate risk of re bleeding + mortality
General management of upper GI bleeds
ABATED
- ABCDE
- Bloods: FBC, U&E, clotting, LFT, G&S, clotting 2 units
- Access: 2 large bore cannla
Transfusion
- Endoscopy within 24 hours
- Drugs - stop anticoagulant + NSAIDs.
.
- non variceal bleeding: clips or thermal coagulation + PPI
- variceal bleeding: variceal band ligation
Additional management of GI bleed is oesophageal varices are suspected
Terlipressin
Broad spec abx
What are peptic ulcers
Ulceration of the mucosa of the stomach or proximal duodenum (most common)
Risk factors of peptic ulcer
- distrupts mucus barrier: H.pylori, NSAIDs
- increase stomach acid: stress, alcohol, spicy foods, caffeine, smoking
What increases the risk of bleeding from a a peptic ulcer?
- NSAIDs
- aspirin
- anticoagulants
- steroids
- SSRIs
Presentation of peptic ulcers
- epigastric pain
- N+V
- dyspepsia
How can you differentiate between gastric + duodenal ulcers?
- gastric ulcers worsen on eating > weight loss due to avoiding eating
- duodenal ulcers improve immediately after eating + worsened 2-3 hours later > weight is stable
Diagnosis of peptic ulcers
- Endoscopy
- Rapid urease test during endoscopy
- Biopsy to exclude malignancy
Management of peptic ulcers
- stop NSAIDs
- treat H pylori - PPI + 2 abx for 14 days e.g. omeprazole + amoxicillin + clarithromycin
- PPIs
- reduce stress, smoking, alcohol
- repeat endoscopy at 4 weeks
Complications of peptic ulcer
- bleeding
- perforation + peritonitis
- scarring + strictures > gastric outlet obstruction
Outline angiodysplasia
- most common vascular abnormality of GI tract
- formation of arteriovenous malformations
- most commonly in caecum + ascending colon
What is the preferred imaging choice for small bowel angiodysplasia?
Capsule endoscopy
Managment of angiodysplasia
- managed endoscopically using argon plasma coagulation
- mesenteric angiography with super-selective catheterisation + emobilisation (if endoscopy not accessible)
