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Hospital Based Medicine And Surgery > L12: GI Bleed > Flashcards

L12: GI Bleed Flashcards

1
Q

What are the 3 main arterial supply of the of the git

A

Coeliac trunk- supplies the stomach, duodenum
Superior mesenteric artery: supplies the midgut (small intestine and aschending
Inferior mesenteric artery- supplies the hindgut

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2
Q

What are the risk factor for an upper GI bleed

A

Drugs: aspirin, NSAIDs, warfarin
Liver disease
Increased age
H.pylori in the stomach that can cause ulceration

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3
Q

What is the colour of the stool in a right sided bleed in the colon

A

Moroon

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4
Q

What colour are stools from a left sided colon bleed

A

Bright red

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5
Q

What are the causes of a lower gi colon bleeed

A

Haemorrhoids
Proctitis
Colorectal cancer
Diverticulosis

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6
Q

What is an upper gi bleed from

A

Oesophagus
Stomach
Duodenum

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7
Q

How does a upper GI bleed present i.e what are the symptoms

A 
Haematemeis- vomiting blood or coffee grounds
Melaena- black/tar stools
Collpase
Anaemia
Abdominal pain
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8
Q

What are the causes of an upper GI bleed

A 
Gastric erosions (gastritis)
Duodenal ulcers 
Gastric ulcers
Oesophageal varices
Mallory weiss tear
Oesphagitis
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9
Q

What is oesophagitis

A

When the stomach acid reflux gets above the g-o junction and passess to the lower oesophageal spinchter which can cause inflammation

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10
Q

What is a mallory weis tear

A

History of foreceul vomiting, on the second vomit there is fresh blood

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11
Q

What is boerhaaves syndrome

A

A tear and perforation of the oesophagus which is more severe

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12
Q

What are the symptoms of boerhaaves syndrome

A

Chest pain

Shock

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13
Q

What are oesophageal varices

A

Varices in the oesophagus that can rupture

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14
Q

What is gastritis often caused by

A

H pylori

NSAID and aspirin use

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15
Q

What does perforation present with

A

Pain and not vomiting blood

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16
Q

What is the assessment of severity of a gi bleed

A 
Pulse more than 100
Bp systolic less than 100
Postural drop in bp
Look for clotting; inr and liver disease
Haemoglobin
17
Q

What is the immediate management of gi bleed

A

Oxygen
Intravenous access of at least 2 with canulla
Group and save and Send a sample for cross match if you need to give blood later
Nothing by mouth
Transfuse blood
Re-assess
Endoscopy

18
Q

What does the rockhall system predict

A

Total score of re-bleeding and mortality

19
Q

What is the blatchford score for

A

Predict the need to treat patients

20
Q

What does a high blatchford score require

A

Endoscopy

21
Q

What does early endoscopy allow

A

Establish diagnosis
Risk assessment
Aids prognosis
Therapeutic procedures

22
Q

What therapeutic procedures can we carry out with endoscpy

A

Adrenaline inject- vasoconstriction of the vessels
Metal clipds
Heater probe
Coagulation powder sprays

23
Q

How can we stabilise the clot after endoscopy

A

Iv PPI e.g omeprazole

24
Q

Why do we use a ppi

A

Pepsin digets clots but is inactive in at ph of greater than 6, we therefore need the ph to go up so we use PPI

25
Q

What is the management of a lower gi bleed

A

Colonoscopy- inject with adrenaline for vasoconstrictors
Angiography- to see where the bleed is from and emboluse the bleeding vessel
Surgery- if bleeding is from cancer

26
Q

What mortality does variceal bleeding have

A

High

27
Q

What does the mortality of variceal bleed increase with

A

Severity of liver disease

Initial fluid status

28
Q

What is the treatment of variceal bleeds

A

Resuscitation
Oxygen
Cross and match and iv access
Antibiotics: often bacteria triggers it or to prevent sepsis
Terlipressing: vasopressin analogue to reduce portal pressue
Endoscop: for band ligation
If bleedin is still uncontrolled to balloon tamponade

29
Q

How can we prevent another variceal bleed in the future

A

Prophylaxis

Eradicate h.pylori

Hospital Based Medicine And Surgery (30 decks)

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