PBL 52 Flashcards
What are the main sites for GI bleeding?
- Upper GI (70%)
- Small bowel GI bleed (<1%)
- Large bowel GI bleed (<30%)
What constitutes the upper GI tract?
Oesophagus, stomach and duodenum
What are the main causes of upper GI bleeds?
- PEPTIC ULCER (50%)
- Varices (10%)
- Gastroduodenal erosions (10%)
- Idiopathic (20%)
- Oesophageal (10%)
Main causes of small bowel bleeding
Jejunal/ileal diverticulae
Main causes of large bowel bleeding
- Angiodysplasia (40%)
- Diverticular disease (40%)
- Carcinoma/polyp (<5%)
- UC/Crohn’s (<5%)
- Haemorrhoids/fissure/fistula
Main approaches to investigation of GI bleeding?
- FBC
- U&E
- Haematinics
- Endoscopy/colonoscopy/CT colonography
Scoring systems for GI bleeding
- Rockall
2. Blatchford
Which of the Rockall and Blatchford scorings systems are better and why?
Blatchford is better because it does not require an endoscopy
What is first line treatment for an upper GI bleed?
Therapeutic endoscopy
- Injection of adrenaline, sclerosants, thrombin or fibrin glue
- Electrocoagulation
- APC
- Clips
How do you treat oesophageal varices?
Injection sclerotherapy
Therapy banding
First line investigations for an acute lower GI bleed
- Normal upper GI endoscopy (to make sure the upper GI tract is fine)
- Colonoscopy
- Angiography - CT or MR angiography
How do you treat polyps during a colonoscopy?
Diathermy and excision
Different methods for visualising the GI tract (7)
- Barium swallow
- Barium enema
- Endoscopy
- Colonoscopy
- Plain X-ray
- Cross-section anatomy
- CT colonoscopy
What are the different barium techniques used to view the upper GI tract?
- Barium swallow (oesophagus –> stomach)
- Barium meal - double contrast (oesophagus –> small intestine)
- Small bowel barium enema (small intestine)
- Double contrast barium enema (large intestine)
Difference between single and double contrast visualising techniques?
- Single contrast - Lumen distended with barium, gives a large vague image, there is poor mucosal detail
- Double contrast - Mucosa coated with barium and lumen distended with air (CO2 etc), there is better mucosal detail with double contract due to mucosal coating so you can see smaller lesions (e.g. adenocarcinomas)
What can single contrasts be used for?
- To check that the patient is aspirating (barium swallow)
- To check vague outline of the GI tract
- To check for pharyngeal pouching (pseudodiverticulum) or pharyngeal bar (constriction)
How is a double contrast barium technique administered?
As a barium meal
- Patients take carbex with lemon juice, produces gas (CO2) in the stomach
- Patient takes barium, then rolls around on the bed to coat mucosa
- Much better mucosal detail
- Double contrast
- Checks for stomach and duodenal conditions e.g. ulcers, tumours
What is a barium swallow?
• A barium swallow is drinking barium liquid (250-500ml):
- Single contrast
- Checks for conditions in the upper GI tract e.g. strictures, pouching
- Appears bright on imaging
- Can miss small lesions
- Well tolerated by patients
- Good for high dysphagia, motility disorders and assessment of anatomy
What is a barium enema?
- Injection of very dilute barium via syringe
- Can be followed by water to wash it round
- Can use double contrast technique (sensitive)
Advantages of double contrast barium enemas?
- Great quality images
- Can be zoomed in and out of
- Safe procedure
- Mostly tolerated well
- Good for detecting intrinsic and extrinsic disease
Disadvantages of double contrast barium enemas?
- Patient must be mobile and able to retain the air
- Not as sensitive as a colonoscopy
- Not tolerated by some patients
- Cant take histological samples
What is the gold standard of visualising the large bowel?
COLONOSCOPY
What sort of lesion is seen with colorectal adenocarcinoma?
Apple core lesion
- Stricture
- Visible on DBCE
What is an endoscopy?
Endoscopy is a procedure in which the GI tract is viewed with a lighted, flexible tube with a camera at the end (endoscope).
- Tissue samples can be obtained by biopsy
- Direct inspection of the mucosa
- Detects early pathology
- Allows biopsy/therapeutic procedure
