L12: GI Bleed Flashcards
What are the 3 main arterial supply of the of the git
Coeliac trunk- supplies the stomach, duodenum
Superior mesenteric artery: supplies the midgut (small intestine and aschending
Inferior mesenteric artery- supplies the hindgut
What are the risk factor for an upper GI bleed
Drugs: aspirin, NSAIDs, warfarin
Liver disease
Increased age
H.pylori in the stomach that can cause ulceration
What is the colour of the stool in a right sided bleed in the colon
Moroon
What colour are stools from a left sided colon bleed
Bright red
What are the causes of a lower gi colon bleeed
Haemorrhoids
Proctitis
Colorectal cancer
Diverticulosis
What is an upper gi bleed from
Oesophagus
Stomach
Duodenum
How does a upper GI bleed present i.e what are the symptoms
Haematemeis- vomiting blood or coffee grounds Melaena- black/tar stools Collpase Anaemia Abdominal pain
What are the causes of an upper GI bleed
Gastric erosions (gastritis) Duodenal ulcers Gastric ulcers Oesophageal varices Mallory weiss tear Oesphagitis
What is oesophagitis
When the stomach acid reflux gets above the g-o junction and passess to the lower oesophageal spinchter which can cause inflammation
What is a mallory weis tear
History of foreceul vomiting, on the second vomit there is fresh blood
What is boerhaaves syndrome
A tear and perforation of the oesophagus which is more severe
What are the symptoms of boerhaaves syndrome
Chest pain
Shock
What are oesophageal varices
Varices in the oesophagus that can rupture
What is gastritis often caused by
H pylori
NSAID and aspirin use
What does perforation present with
Pain and not vomiting blood
What is the assessment of severity of a gi bleed
Pulse more than 100 Bp systolic less than 100 Postural drop in bp Look for clotting; inr and liver disease Haemoglobin
What is the immediate management of gi bleed
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
What does the rockhall system predict
Total score of re-bleeding and mortality
What is the blatchford score for
Predict the need to treat patients
What does a high blatchford score require
Endoscopy
What does early endoscopy allow
Establish diagnosis
Risk assessment
Aids prognosis
Therapeutic procedures
What therapeutic procedures can we carry out with endoscpy
Adrenaline inject- vasoconstriction of the vessels
Metal clipds
Heater probe
Coagulation powder sprays
How can we stabilise the clot after endoscopy
Iv PPI e.g omeprazole
Why do we use a ppi
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
What is the management of a lower gi bleed
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
What mortality does variceal bleeding have
High
What does the mortality of variceal bleed increase with
Severity of liver disease
Initial fluid status
What is the treatment of variceal bleeds
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
How can we prevent another variceal bleed in the future
Prophylaxis
Eradicate h.pylori
