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Finals: Medicine > Upper GI Bleed > Flashcards

Upper GI Bleed Flashcards

1
Q

Define the term “Haematemesis”

A

vomiting up fresh blood

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2
Q

Define the term “Melaena”

A

passing of black tarry faeces discoloured by the presence of digested blood.

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3
Q

What causes “coffee ground” vomit

A

caused by vomiting digested blood that looks like coffee grounds.

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4
Q

What is the classic presentation of a patient with an upper GI bleed

A

Patients commonly present with haematemesis and/or melaena and may have features of shock (e.g. hypotension, collapse).

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5
Q

Name the three causes that account for the majority of upper GI bleeds

A

Peptic ulcer disease

Gastritis

oesophageal varices

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6
Q

Name the 2 causations of peptic ulcer

A

Helicobacter pylori

The use of NSAIDs

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7
Q

Name some of the oesphageal causes of upper GI bleed

A

Varices

Oesphagitis

Maligancy

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8
Q

Name some of the gastric causes of upper GI bleed

A

Peptic ulcers

Gastritis

Mallory-Weiss

Malignancy

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9
Q

Name some of the duodenal causes of upper GI bleed

A

Peptic ulcers

Duodenitis

Diverticulum

Aorto-duodenal fistula

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10
Q

What are oesphageal varices

A

Abnormal, dilated veins that occur at the lower end of the oesophagus

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11
Q

Oesophageal varices occur secondary to portal hypertension most commonly secondary to cirrhosis.

Describe the physiology on how portal hypertension can cause oesphageal varcies

A

Increases in portal pressure lead to the development of a collateral circulation to overcome the obstruction to flow in the portal system.

The lower end of the oesophagus forms an important ‘portacaval anastomosis’which allows the flow of venous blood from the portal system to the systemic circulation.

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12
Q

Several risk factors increase the likelihood of a patient developing an upper GI bleed.

Name some of these risk factors

A

NSAIDs

Anticoagulants

Alcohol abuse

Chronic liver disease

Chronic kidney disease

Advancing age

Previous peptic ulcer disease or H. pylori infection

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13
Q

What is the main diagnostic test for upper GI bleed

A

Upper GI endoscopy

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14
Q

Upper GI endoscopy is the main diagnostic test for upper GI bleed.

Within what time scale should this be completed

A

immediately in any unstable patient following initial resuscitation

within 24 hours in all other patients

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15
Q

Early risk stratification helps identify high-risk patients & need for prompt intervention.

Name the two scoring systems used in upper Gi bleed

A

Blatchford score

Rockall

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16
Q

Which upper GI bleed scoring system is recommended during the primary assessment

A

Blatchford score

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17
Q

Which upper GI bleed scoring system takes into account endoscopy findings

A

Rockall scoring

18
Q

Name some of the components of the Blatchford score

A

Drop in Hb

Rise in urea

Blood pressure

Heart rate

Melaena

Syncope

19
Q

Why is there a rise in urea in upper GI bleeds

A

the blood in the GI tract gets broken down by the acid and digestive enzymes.

One of the breakdown products is urea and this urea is then absorbed in the intestines.

20
Q

What are the components of the Rockall scoring system

A

Mnemonic ABCDE:

A - Age

B - Blood pressure (and heart rate)

C - Comorbidity

D - Diagnosis

E - Endoscopic findings

21
Q

What is the most common cause of non-variceal upper GI bleeding

A

Peptic ulcer disease

22
Q

The risk of rebleeding of non-variceal upper GI bleeds, which influences the need for intervention, depends on

A

The endoscopic findings of the ulcer.

23
Q

If based on the endoscopic findings. If the non-variceal upper GI bleed is deemed high risk of rebleeding

What is the next management option

A

Endoscopic intervention (Endo-therapy)

24
Q

What techniques are employed in endo-therapy to treat the bleed

A

Adrenaline injection

Thermal coagulation by a heater probe

Mechanical e.g. endoscopic clips

Haemostatic powders

(thrombin, laser)

25
Q

When should IV proton pump inhibitor therapy be considered in the treatment of non-variceal upper GI bleed

A

in high risk patients and only after endo-therapy

26
Q

When should you transfuse with fresh frozne plasma

A

if the patients INR > 1.5 due to coagulopathy.

27
Q

If the non-variceal bleeding is not controlled by endo-therapy, what is the next management step

A

radiological embolisation or surgical intervention.

28
Q

Name the 3 Pharmacological intervention of a variceal upper GI bleed

A

Terlipressin (IV injection)

Prophylactic antibiotic therapy

Non-selective beta blockers

29
Q

Terlipressin is an analogue of what hormone

A

vasopressin (ADH)

30
Q

Describe the mechanism of action of Terlipressin in managing variceal upper GI bleeds

A

Causes splanchnic vasoconstriction

This reduces portal pressures

Used only temporarily

31
Q

What does Prophylactic antibiotic therapy do in the management of variceal upper GI bleed

A

Helps to reduce rebleeding and mortality

32
Q

Give an example of a non-selective beta blocker

A

Propanol

33
Q

Describe the mechanism of action of non-selective beta blockers in managing variceal upper GI bleeds

A

Causing splanchnic vasoconstriction

This reduces portal pressure

34
Q

What is the endoscopic intervention in the management of variceal upper GI bleeds

A

Variceal band ligation (VBL)

35
Q

What is involved in Variceal band ligation (VBL)

A

Rubber bands are put on the varices which occlude the blood vessels and the bands eventually fall off and the collateral should disappear.

36
Q

How often do patients have to undergo variceal banding programme

A

every 2-4 weeks until varices have gone.

37
Q

If the varices are not controlled by endo-therapy and pharmacological intervention then what are the two further options

A

Trans-jugular intrahepatic stent shunt (TIPS) - first choice failed invention

Sengstaken tube

38
Q

Which therapy if the 1st choice of failed invention for variceal bleeds

A

Trans-jugular intrahepatic stent shunt (TIPS)

39
Q

Describe what is involved in Trans-jugular intrahepatic stent shunt (TIPS)

A

Interventional radiological procedure.

Radiologist create a shunt between the portal and hepatic vein, which shunts the high pressure blood into the systemic venous circulation to reduce the portal pressure.

40
Q

Name a potential complication of Sengstaken tube

A

Bridging therapy

Temporary as at risk of oesophageal necrosis if left > 24 hours.

Finals: Medicine (91 decks)

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