GI Bleeds Flashcards
four clinical presentations of upper GI bleeds - describe the location of where they would occur:
- haematemesis
- bleeding PR
- melena
- coffee ground vomiting
- fresh red blood vomiting from upper GI origin
- fresh red blood from lower GI origin
- digested blood from upper GI origin
- lower upper GI bleed - acted upon by stomach acid and been there for longer.
how much blood do you have to lose to be haemodynamically unstable?
how will this present in:
- children
- old and frail
what bpm and systolic BP?
500ml
- children: just tachycardic as it takes a lot for them to be hypotensive
- old and frail: tachycardic and low BP
> 100bpm + <100mmHg
if someone has stopped producing melena - have they stopped bleeding?
yes - as blood is a good laxative
what Ix would you do for a GI bleed?
what fluids would you give if they are haemodynamically unstable?
what is your next step if the patient is on anticoagulation?
FBC, U+E, LFT,
Group + Save
Hartmann’s
stop it and reverse it if on warfarin (give Vit k)
Why do you need to look at the urine output if they are a GI bleed patient?
whats a normal urine output?
to see if there is enough circulatory replacement ( will pass urine if they have enough fluid)
> 35ml/hour
Most common causes of UPPER GI bleeds?
if a 30 yr old w/ haematemesis
if a 70 yr old w/ haematemesis
- peptic ulcers (40%)
- gastritis (28%)
- oesophageal varices (14%)
- oesophagitis
= most likely oesophageal varices.
= most likely peptic ulcer.
Most common causes of LOWER GI Bleeds?
- Diverticular Disease (most common)
- Polyps
- Malignancy (mostly rectum)
- IBD
- Ischaemic colitis
Questions to ask for peptic ulcer:
Alcohol abuse
Smoking
H. pylori infection
NSAIDs