GI Bleeds Flashcards
What are some common causes of upper GI bleeding?
Peptic ulcer disease Erosive oesophagitis Esophageal varices AVM Mallory weiss tear Cancer causing bleeding
What are some causes of lower GI bleeding?
Diverticulosis CRC Hemorrhoids AVM Intestinal ischemia
What are some signs of upper GI bleeding?
Haematemesis- vomiting of blood
Malena- if it has digested
What blood tests should be done for suspected upper GI bleeds?
FBC- initially normal but this declines U and Es- Urea levels can be sign of location of the bleeding AST, ALT, Gamma GT, Bilirubin, Albumin Clotting studies Group and save- in case of transfusion
What approach should you have for the management of upper GI bleeding?
ABCDE- its a medically emergency
What puts someone at risk of developing an upper GI bleed?
Chronic NSAID usage Peptic ulcer disease H.Pylori infection Liver disease leading to esophageal varices Recurrent severe vomiting
How are patients with an upper GI bleed assessed?
Blatchford score- scores of 6 or more indicate a need for intervention
If someone is bleeding what should be done to resuscitate them?
IV Fluids- Saline or Hartmann’s
What methods might be used to resuscitate the patient?
Activate major haemorrhage protocol if indicated
Fluid resus via two large bore cannulas
Blood Products- Red cells, FFP, Frozen Cryoprecipitate if indicated
What should patients be done for patients with an unstable upper GI bleed?
Urgents upper GI endoscopy after resus
What should be done for patients with a stable upper GI bleed?
Endoscopy within 24 hours
What might be done during endoscopy to stop the bleed?
Management depends on whether it is a variceal bleed or not:
Variceal bleeds- clipping, band ligation, TIPS
Non Variceal bleeds- thermal coagulation, adrenaline injections, fibrin or thrombin injections
What should be given for patients found to have an upper GI bleed due to varices?
Terlipressin- causing splanchnic vasoconstriction and so reduces blood loss
What should be given for fluid resus?
500ml over 15 minutes
Then re-assess and repeat
What scoring system can be used to estimate the severity of GI bleeding after endoscopy?
The Rockall Score
Or Haemorrhagic Shock Classifications
What is the test to check for H.Pylori infection?
CLO Test - checks for the urease enzyme which is present if there is a H.Pylori infection
Colour change is seen from yellow to red
What test can be done to check for H.Pylori?
Carbon-13 Urea breast test
Stool antigen
(depends what is available)
What is the treatment for H.Pylori?
PPI + Amoxicillin + Clarithromycin or Metronidazole
If Penicillin allergic- PPI + Clarithromycin + Metronidazole
What should be done to check if the eradication therapy was successful?
Urea breath test 8 weeks after eradication therapy
Stop taking the PPI one week before the breath test
What blood tests can check for liver disease?
LFTs
Clotting
Platelets- Low platelet count often seen
Albumin
Note- variceal bleeds rarely occur in patients with normal platelet count.
What medication should be given to reduce the risk of variceal bleeds?
Propranolol
What does a TIPS do?
Reduces portal pressure by creating a stent between the hepatic vein and portal vein thereby bypassing the liver
TIPS stands for Transjugular intrahepatic portosystemic shunt
What are mallory weiss tears associated with?
Forceful repeated vomiting often in alcoholics
There are episodes of bleeding and then blood in the vomit
What are some causes of lower GI bleeding?
CRC Haemorrhoids Diverticular disease Polyps Intestinal ischaemia
What is a big risk factor for bowel ischaemia?
AF
How does ischemic colitis present?
Sudden onset abdominal pain
Blood in the stool
Bowel obstruction/perforation if necrotic tissue
Sepsis if bowel obstruction
What investigation should be done for acute bowel ischaemia?
CT Abdomen
