GI Bleeds (Upper & Lower) Flashcards
What are some common causes of upper GI bleeds?
Upper GI Bleeds can be caused by:
- Peptic (stomach) ulcers
- Ruptured Oesophageal Varices
- Oesophageal Tear/ Mallory-Weiss Syndrome (MWS- tear in gastro-oesophageal junction- caused by forceful vomiting, severe coughing)
What are some common causes of lower GI bleeds?
Lower GI bleeds can be caused by:
- Haemorrhoids
- Anal fissures
What are some generalised symptoms someone may experience with a GI bleed?
Abdo pain/discomfort, hypotension (blood loss causes hypovolaemia), tachycardia
What type of shock could someone with a GI bleed go into? and what are the 2 stages of this shock?
They may go into Hypovolaemic Shock (from volume loss)
Stage 1- Compensatory Stage (normal BP + tachy- high HR is keeping the BP up)
Stage 2- Decompensatory Stage (low BP + tachy- the high HR has failed to maintain the BP)
What are some key signs that someone is having an UPPER GI bleed? (eg. from a ruptured oesophageal varices)
[Hint- what will their: vomit look like (2 types) & poo look like?]
Upper GI bleed:
Vomit=
a) Coffee ground vomit (coagulated blood)
b) Hematemesis (vomiting up bright red blood)
Stool= Melena (dark black stool)
What are some key signs that someone is having an LOWER GI bleed? Explain how & why this is different to upper GI bleed S/S
[Hint- what will their: poo & vomit look like?]
LOWER GI BLEED:
POO= Bright red blood- this is different to the Melena (dark black) stools in upper GI bleeds as the blood hasn’t been oxidised/interacted with the gastric acid/enzymes in the stomach (as the bleed is occurring after the stomach)
VOMIT= no blood/coffee grounds in the vomit- the bleed is occurring below the level of the stomach
If someone has an Upper GI Bleed, their vomit may be described as- ‘Coffee ground vomit’ or ‘Hematemesis’. What is the difference between the 2?
[Explain the process behind each type]
Upper GI Bleeds can cause blood to appear in the vomit:
HEMATEMESIS= vomiting bright red blood- suggests the bleed is more acute/severe
COFFEE GROUND= vomit has coagulated blood in it. Blood + Gastric Acid= blood clotting- Often indicates a less severe/acute bleed & that the blood has been sitting in the stomach for a bit
If someone has an Upper GI Bleed they may experience Melena. What is this? and what causes it?
Upper GI bleeds can cause Melena:
MELENA= dark black stool
Cause= Upper GI bleed > blood goes into stomach > gastric acid/digestive enzymes turn it black & give it a very offensive smell
What is Mallory Weiss Syndrome (MWS) & what can cause it? Would it cause an upper or lower GI bleed?
Mallory-Weiss Syndrome (MWS)
= An Oesophageal Tear- the tear occurs in the gastro-oesophageal junction.
Cause= caused by forceful vomiting, severe coughing
The following parts of the GI system are in a random order. If a bleed was occuring in the part, would it be classified as an UPPER or LOWER GI bleed:
> Jejunum, Oesophagus, Duodenum, Anus, Stomach, ilium, colon/large intestine
A bleed in each of the following areas of the GI tract would indicate:
JEJUNUM= lower (after duodenum, middle of small intestine)
OESOPHAGUS= upper
DUODENUM= upper (upper portion of small intestines)
ANUS= lower
STOMACH= upper
ILIUM= lower (end of small intestine, before large)
COLON/LARGE INTESTINE= lower
What is the ligament called that is used to anatomically divide the GI System into the ‘UPPER GI’ and ‘LOWER GI’?
The LIGAMENT of TREITZ is what anatomically divides the GI system into the Upper GI (above the ligament), and Lower GI (below the ligament)
Why does an UPPER GI bleed cause/trigger vomiting?
In large volumes, blood acts as an emetic and can trigger vomiting
In what cases would an Oesophageal Varices bleed (upper GI bleed) cause bright red blood in the stool INSTEAD of the typical Melena?
If the bleeding from the Oesophageal Varices is so rapid & significant, then it may not have time to fully mix with gastric acid and it ends up exiting the body in a relatively unchanged state.
[Fun fact- “It is estimated that 15% of bright red blood in the stool originates in the upper GI tract”]
What are 3 acute/ life threatening complications of a ruptured OESOPHAGEAL VARICES that paramedics should watch for? Briefly explain how oesophageal varices can cause each
- Massive Hypovolaemia & Hypovolaemic Shock
Why? Hypovolaemia occurs from a decrease in blood volume. Shock results from hypovolaemia causing a mismatch between oxygen supply & demand, then leading to circulatory failure - Aspiration & Aspiration Pneumonia Why? decreased GCS from hypovolaemia, while still vomiting can cause vomit/blood to go into the lungs. This can then cause an infection (pneumonia)
- Exacerbation of Hepatic Encephalopathy in those with Liver Disease (causing reduced GCS & increased ICP)
Why? Their liver already lacks ability to properly filter out toxins/amonia from their blood (causing encephalopathy), now there is even more blood produced & not being filtered causing more toxins/ammonia & worsening neuro deficits
What would your pre-hospital management look like for someone with a severe Oesophageal Varices rupture?
[assume they have a reduced GCS & are still vomiting]
OESOPHAGEAL VARICE RUPTURE:
1. Airway= position on side, no airway adjuncts as this will increase risk of aspiration. ETT is the most optimal way of airway support which prevents aspiration.
2. Breathing= if breathing support is required with a BVM, ensure overinflation of stomach is prevented as this can precipitate more vomiting & increase risk of aspiration
3. Circulation= large bore cannula & give fluids- titrate until radial pulse is restored (in line with traumatic hypovolaemia protocol). Avoid excessive fluid administration as this can overdilute clotting factors (which are already low due to liver disease)
