Others - GI Bleed

Question 1

Causes of Upper GI Bleed

Answer 1

• Peptic ulceration – 40% of presentations. Duodenal and gastric.
• Gastric erosions and gastritis
• Reflux oesophagitis
• Varices – oesophageal and gastric
• Mallory Weiss tear
• Miscellaneous – malignancy, coagulation disorders, Dieulafoy’s lesion, aorto-enteric fistula, vascular malformations

Question 2

Pathophysiology of Upper GI bleed

Answer 2

• UGIB – Source is proximal to Ligament of Trietz
• Multiple causes: divided into variceal and non-variceal.
• Variceal – portal hypertension leads to porto-systemic collaterals (oesophageal and gastric varices) and shunting of blood.
• Ulcer–related UGIB – strongly related to H.pylori infection
• Acute stress gastritis – mucosal barrier affected by
- action of medications/drugs - NSAIDs, ETOH, steroids,
- reflux oesophagitis, or hypersecretion of acid (ZE syn)
- Ischaemia – in setting of shock,sepsis, and Trauma.
- MalloryWeisstear

Question 3

How do Upper GI Bleeds Present?

Answer 3

• Haemetemesis: fresh blood or altered - ‘coffee grounds’ • Melaena – black tarry stools
• Haematochezia - bloody stools
• Collapse and shock
• Syncope or postural hypotension • Fatigue, SOB, angina
• PMH
• Medications
• Signs of volume depletion
• Abdominal signs, stigmata of chronic liver disease, rectal exam

Question 4

Management of Upper GI Bleed

Answer 4

• ABC approach
• IV access
Management of UGIB
• Bloods including cross-match
• PPI – For instance (NICE) after endoscopy in non-variceal bleeds with stigmata seen of recent bleed on endoscopy
• Antibiotics
• Terlipressin – for oesophageal varices
• Cimetidine
• Expedite Endoscopy
• Blood products
• Interventional radiology
• TIPPS

Question 5

Causes of lower GI Bleed

Answer 5

• Source below Ligament of Trietz
• Causes commonly Haemorrhoids, Diverticulitis, IBD, Angiodysplasia, Neoplasia, UGIB, Ischaemic colitis, Radiation enteropathy

Question 6

Red flags for lower GI Bleed

Answer 6

Red flags include age, change of bowel habit, weight loss, anaemia, assoc abdo pain, fever, etc