GI haemorrhage

Question 1

leading cause of upper GI bleeding?

Answer 1

peptic ulceration

Question 2

resuscitation with upper GI bleed?

Answer 2

O2
pulse oximetry- SpO2, NIBP
seek features of alcoholic liver disease
FBC, Us and Es, LFTs, cross-match and clotting studies
give Vit K and FFP if liver disease suspected
blood, can give O -ve without crossmatch, can start colloids/crystalloids whilst waiting for blood, part. if minimal hypotension, but these disturb fluid balance in ascitic ptnts.
NG aspiration- allows gastric contraction and reduce aspiration chances. Aspiration pneumonia= signif cause of death.
CVL and urinary catheter

Question 3

endoscopic therapy for upper GI bleeding?

Answer 3

injection sclerotherpay
argon beam coagulation
diathermy
laser
heater probe

Question 4

tments for bleeding oesophageal varices?

Answer 4

intravariceal sclerotherapy/banding
vasopressin/somatostatin- reduce portal pressure
sengstaken-blakemore/Minnesota tube
portasystemic shunts

Question 5

endoscopic appearances of acute erosive gastritis?

Answer 5

multiple brown coloured areas size and shape of tea leaves

pharmacol. suppression of acid secretion =tment

Question 6

tment for resistant cases of Mallory-Weiss tears?

Answer 6

endoscopic electrocoagulation

Question 7

most common cuase of Mallory-Weiss tear?

Answer 7

violent vomiting after consumption of large meal with alcohol

Question 8

commonest tumours to cause major upper GI bleeds?

Answer 8

leiomyomas or sarcomas (GI stromal tumours)
recognised on endoscopy as yellowish polyp with an ulcer crater on surface.
local excision tment= curative

*contrast to gastric carcinomas- ooze slowly causing anaemia.

Question 9

what is a dieulafoy malformation?

Answer 9

rare hamartomatous lesion presenting with large, painless haematemesis.
endoscopy often -ve
commonest location of lesion= stomach
lesion= large b.vessel in SM which bleeds easily and intermittently.

Question 10

colour of blood passed PR if from small bowel or proximal colon?

Answer 10

dark red or black, but not sticky consistency and smell assoc. with partially digested blood from upper GI bleeding= melaena.

Question 11

presentation of infective colitis e.g. due to campylobacter?

Answer 11

frank bleeding per rectum, and lower abdom pain

Question 12

when does diverticular disease present with bleeding?

Answer 12

impacted faecoliths erode blood vessels which penetrate neck to neck of diverticulum.
NOT if inflammation as mural oedema distances vessels from impacted faecoliths.

Question 13

where is angiodysplasia most commonly found?

Answer 13

R colon

Question 14

how can a meckel’s diverticulum present with lower GI bleeding- dark blood passed PR?

Answer 14

presence of gastric mucosa in diverticulum, gastric acid produced which causes peptic ulcer development in adjacent ileum.

Question 15

indication of andidysplasia on sigmoidoscopy?

Answer 15

bright red patches of dilated vessels in colonic mucosa

can treat with colonscopic laser or diathermy

Question 16

investigations of lower GI bleeds?

Answer 16

endoscopy
radiolabelled red cell scanning
selective mesenteric angiography

Question 17

role of LFTs in assessing upper GI haemorrhage?

Answer 17

if raised, may be indicative of liver cirrhosis causing portal hypertension and opening up of porto-systemic anastomoses, producing oesophageal varices which may rupture, causing haematemesis.