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GI > GI Haemorrhage > Flashcards

GI Haemorrhage Flashcards

1
Q

describe melaena

A

black, thick, sticky, semi liquid stool

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2
Q

what is vomiting blood called

A

haematemesis

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3
Q

what are the most common causes for a GI bleed

A

duodenal ulcer, gastric erosions, gastric ulcer, varices

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4
Q

what is a mallory-weiss tear

A

distal oesophageal tear due to repeated vomiting

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5
Q

what is the immediate treatment for a GI haemorrhage

A

resuscitation, ABC: airway protection, oxygen, IV access, fluids

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6
Q

why must a grey IV access cannula be used

A

as it is the largest bore, 2 can maintain pace of GI bleed

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7
Q

what is the 100 rule

A 
used to assess the severity- people in a poor prognostic group
systolic BP < 100mmHg
pulse > 100 bpm
Hb < 100
age > 60
comorbid disease 
postural hypotension
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8
Q

what else might affect people ability to compensate for a GI bleed

A

diabetes- poor autonomic response

beta blockers

young people compensate well but crash hard if below 1.5 litres of blood (average in adult is 5 litres circulating)

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9
Q

what is an OGD

A

oesophageal gasto duodenoscopy

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10
Q

what is the uses of the OGD

A

identify cause, therapeutic manoeuvres, asses risk of rebleeding

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11
Q

what co morbiditys increase the rockall risk scoring system

A

2:
IHD, CCF,
3:
renal or liver failure, malignancy

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12
Q

what are features of a high risk ulcers/ the stigmata of recent haemorrhage

A

active bleeding/oozing, overlying clot, visible vessel

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13
Q

what does the blatchford score assess

A

risk of GI bleed- a score of 0-1 means patient can be discharged with arrangement for later endoscopy

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14
Q

what are the treatments for a bleeding peptic ulcer

A 
endoscopic treatment (high risk ulcers)
acid suppression (infusions omeprazole) 
intervention radiology 
surgery
H. pylori eradication (secondary prevention)
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15
Q

what is involved in the endoscopic treatment of peptis ulcers

A 
injection 
heater probe coagulation 
combinations
clips 
haemospray
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16
Q

how does an endoscopic injection work to stop a peptic ulcer bleeding

A

as injection of adrenaline shifts the thrombotic- fibrinolytic (acid and pepsin in lumen) balance towards clot formation (fibrinolysins in blood vessel)

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17
Q

what is endoscopic dual therapy

A

injection + heater probe/ clip

18
Q

how dilated is the adrenaline in an endoscopic injection

A

1:10000

19
Q

where are the endoscopic clips placed

A

on vessels one either side of ulcer

20
Q

what is hemospray

A

When Hemospray comes in contact with blood, the powder absorbs water, then acts both cohesively and adhesively, forming a mechanical barrier over the bleeding site.

21
Q

what is the purpose of acid suppression and what is used to do this

A

prevents re bleeding- IV omeprazole

22
Q

what is the treatment pathway of a successfully treated peptic ulcer

A

PEPTIC ULCER AT ENDOSCOPY
(bleeding or with stigmata of recent haemorrhage)

adrenaline injection/heater probe thermo-coagulation/clips

bleed stops

omeprazole 80mg iv
+
8mg/hr/72hrs ivi

H. pylori eradication
as appropriate and
course of oral PPI

23
Q

what should yuo do if there is a re-bleld of a peptic ulcer after dual therapy

A

omeprazole 80mg iv
+
8mg/hr/72hrs ivi

Further attempt at
endoscopic therapy

(if bleed continues)

surgery

24
Q

what is a ppi and give exmaple

A

proton pump inhibitor, acid suppressor, omeprazole

25
Q

what is the main cause of variceal bleeds

A

liver disease- cirrhosis- portal hypertension

26
Q

what is the main complication of liver diease

A

sepsis

27
Q

what is childs score

A

measure of severity of liver disease, A, B, C- C most severe

28
Q

what are the risk factors for a variceal bleed

A
  • portal pressure > 12mmHg
  • varices > 25% oesophageal lumen
  • presence of red signs (mucosal weakening)
  • degree of liver failure (Child’s A<b></b>
29
Q

why is the mortality of variceal bleeds so high (25-50%)

A

due to complications - sepsis, liver failure

30
Q

what is the anatomy of varises

A

As cirrhosis advanced resistance to portal vein increases which increases portal pressure
Blood tries to find other way back than through the liver- drain upwards through the parioesophageal venous plexus to try and get back to azygous vein, vessels distend and causes oeshophageal varisces

31
Q

what would make you suspect varices in a patient with a GI bleed

A 
known history of cirrhosis with varices 
history;
-chronic alcohol excess
-chronic viral hepatitis infection 
-metabolic/ autoimmune liver disease 
-intra-abdominal sepsis/surgery

on examination:
-stigmata of chronic liver disease

32
Q

what are the stigmata of chronic liver disease

A

spider naevi, palmar erythema, encephalopathy (nuerotoxic effect on the brain, liver flap, drowsy, inability to copy 5 sided star), ascites, jaundice, leukonychia

33
Q

what are the aims of management of a variceal GI bleed

A 
Resusciation
Haemostasis
Prevent complications of bleeding
Prevent deterioration of liver function
Prevent early re-bleeding
34
Q

what ions might need to be replaced in a GI bleed

A

K+, MG2+ and (PO4)2-

35
Q

how is haemostasis

A

Terlipressin (vasopressin analogue- constricts blood supply to the gut so reduces portal pressure)

Endoscopic variceal ligation (banding)

(Sclerotherapy)

Sengstaken-Blakemore balloon

TIPS- decompresses portal venous system

36
Q

what is terlipressin

A

vasopressin pro drug- splanchnic vasoconstrictors, beneficial effect of renal perfusion

37
Q

when should a sengstaken- blakemore tube be used

A

as a delay until endoscope

38
Q

what is TIPS

A

blood shortcuts liver and goes straight to systemic venous system reducing portal pressure

39
Q

why is propanolol used in a variceal bleed

A

to reduce portal blood pressure

40
Q

why is banding used in variceal bleeds

A

is a further procedure to completely get rid of varices

GI (64 decks)

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