GI BLOOD LOSS

Question 1

Whats the most common site for GI bleeding?

Answer 1

upper GI tract 70%

Question 2

what are haemorrhoids?

Answer 2

swellings containing enlarged blood vessels found inside and around the anus

Question 3

what proportion of the adult population will have haemorrhoids at some time in their life?

Answer 3

90%

Question 4

what proportion of adult population will bleed rectally per year?

Answer 4

50%

Question 5

what is usually the underlying cause for the adult population bleeding from the rectum occasionally?

Answer 5

constipation

Question 6

whats the biggest cause of upper Gibleeding?

what are some others?

Answer 6

peptic ulcer
oesophageal issues
gastroduodenal erosions
varices

Question 7

what are the main causes of small bowel bleeding?

Answer 7

jejunal or ill diverticulae

Question 8

what are the main causes of large bowel bleeding?

Answer 8

angiodysplasia 40%
diverticular disease 40%
carcinoma
polyps
UC and crohns
haemorrhoids

Question 9

what is meckels diverticulum?

Answer 9

embryological remnant of gastric mucosa in the terminal ileum

Question 10

whats the clinical presentation of GI bleeding?

Answer 10

• melaena
• haematemesis
• shock and hypotension and tachycardia
• bright red rectal bleeding

Question 11

whats the clinical presentation of chronic GI bleeding?

Answer 11

anaemia symptoms e.g. fatigue, SOB

Question 12

whats the overall mortality for acute GI bleeds?

Answer 12

14%

Question 13

how do we manage acute GI bleeds?

Answer 13

resuscitation
endoscopic therapy
PPI

Question 14

what factors make a patient significantly higher risk from dying from an upper GI bleed?

Answer 14

being over 65
having co orbities
shock 
continued bleeding or rebleeds
suspected vatical haemorrhage

Question 15

what are the 2 scoring systems for upper GI bleeds?

Answer 15

Rockall and Blatchford

Question 16

outline rockall scoring system?

Answer 16

takes into account age, pulse, bp, comorbidities, endoscopic diagnosis, stigmata
as score goes up, mortality goes up

Question 17

outline Blatchford scoring system?

Answer 17

measures urea, Hb, Bp, pulse, syncope, melaena, cardiac/liver disease

Question 18

why is urea elevated in Gi bleeding?

Answer 18

as blood is digested and the protein is broken down to produce urea.

Question 19

how soon should patients get endoscopy if they have a GI bleed?

Answer 19

within 24 hours but sooner if someone is high risk or there are suspected varices

Question 20

what are some examples of endoscopic therapy?

Answer 20

injections of adrenaline, sclerosants, thrombin glue
electrocoagulation
clips
argon plasma coagulation