Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastro > Management of Acute Upper GI Haemorrhage > Flashcards

Management of Acute Upper GI Haemorrhage Flashcards

1
Q

What is haematemesis?

A

Blood in the vomit - upper GI bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is melaena

A

Blood in the stool - A sign of Upper GI bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is GI bleeding?

A

A serious medical emergency until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the majority of GI bleeds

A

Self limiting with no in-hospital rebleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the mortality rate for patients with continued or recurrent bleeding?

A

30-40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What can cause upper GI bleeding

A 
duodenal ulcer
gastric erosions
gastric ulcer
varices
Mallory -Weiss tear (repeated vomiting and then the appearance of blood)
Oeophagitis
Erosive duodenitis
neoplasm
stomal ulcer
oesophageal ulcer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How can you control the blood pressure of a patient?

A

IV access to give fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What venflon should be used with GI bleeding?

A

Grey venflon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the 100 rule?

A

systolic BP 100bpm
Hb 60
Comorbid disease
Postural drop in blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How many litres of circulating volume do you have?

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How much can you afford to lose at a young age?

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How much volume can you afford to lose at an older age?

A

1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do you do if there is a high suspicion of GI bleed and what does this tell you?

A

Endoscopy
to identify the cause
to manage the cause
assess the risk of rebleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What scoring system is used for to measure the risk of a upper GI rebleed ?
What is it scored on?

A 
Rockall RIsk Scoring system 
age 
pulse 
SBP 
Presence or absence of co-morbidity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does the Blatchford Scoring system determine?

Why is this advantageous of the Rockall RIsk Scoring System

A

The high risk of GI bleeding patients

It does not require an endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do we do for patients that score 0-1 on the Blatchford Scoring system?

A

Require an outpatient endoscopy

17
Q

What are the 3 high risk stigmatas of recent haemorrhage

A

Active bleeding/ oozing
Overlying clot
Visible vessel

18
Q

How can you achieve haemostasis

A

Get a balance of thrombosis and thrombolysis

19
Q

What are the endoscopic treatments of peptic ulcers?

A

Injection (best is 1/10000 adrenaline - gives a tamponade effect and a pharmacological effect of vasoconstriction)
Heater probe coagulation
Combinations
Clips - apply to achieve haemostasis
Haemospray - new device used as rescue therapy when the rest has not worked

20
Q

What is the combination therapy?

A

Injection and heater probe coagulation

21
Q

What is acute variceal bleeding

A

Varices are dilated submucosal veins, most commonly detected in the distal esophagus or proximal stomach

22
Q

What causes variceal bleeding?

A

Cirrhotics

Complications such as sepsis and liver failure

23
Q

What does intervention do in acute variceal bleeding?

A

Reduced bleeding related mortality

24
Q

What happens as the resistance in the portal vein increases

A

The pressure increases and so the flow changes to try and find an alternative route back into the systemic system

25
Q

When do you suspect varices in a bleeder?

A

Known history of cirrhosis with varices
History of chronic alcohol excess
Chronic viral hepatitis infection
metabolic or autoimmnue liver disease - intra-abdominal spesis/ surgery

26
Q

What causes leukonychia?

A

Chronically low protein levels

27
Q

What can portal hypertension cause

A

Spider naevi
Ascites
Encepalopothy
Leukonychia

28
Q

What are the aims of management of variceal bleeding?

A 
Resuscitation
Haemostasis
Prevent complication of bleeding
Prevent deteriorating liver failrure 
Prevent rebleed
29
Q

How do we achieve coagulopathy

A

Plasma donor and give Vitamin K

30
Q

Why do we always give antibiotics to patients with variceal bleeding

A

people with cirrhosis - overall improves their mortality

31
Q

How do we achieve haemostasis is varices?

A

Terlipressin (vasopressin analogue)
Endoscopic variceal ligation (banding)
Sclerotherapy - now not used as much due to high complications.
Sengestaken-Blakemore balloon - emergency situations
TIPS - in radiology - stent in the liver to reduce pressure in portal vein

32
Q

What is Sengstaken- Blakemore Tube

A

it is a balloon into the stomach that is pulled back against the gastro-oesophageal junction causing increased pressure and it will tamponade

33
Q

TIPS

A

Transjugular intrahepatic portosystemic shunt (TIPS). This is a procedure to create new connections between two blood vessels in your liver. This can decrease pressure in the veins and prevent bleeding episodes from happening again.

34
Q

Why is propranolol used in variceal bleeds?

A

To reduce the pressure in the portal system

35
Q

What happens if the hepatic function remains poor even after TIPS

A

Consider a transplant

Gastro (67 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions