upper GI bleed TBL Flashcards

1
Q

where is haematemesis blood from?

A

proximal to jejunum

usually fresh

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2
Q

where is malaena blood from?

A

proximal to caecum

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3
Q

What is haemobilia?

A

blood in biliary tree

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4
Q

what does fresh red blood indicate?

A

coming from a vessel

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5
Q

what are some signs of a large bleed?

A
dizziness
postural syncope
collapse
short of breath
altered consciousness
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6
Q

do all patients with upper GI bleed get a PR exam?

A

yes

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7
Q

how is upper GI bleed managed?

A
ABCD
A - ensure patent airway
B - oxygen
C - bloods including cross match, 2 large bore cannula, recus with blood/fluids
D - glucose
consider referral
consider drugs (PPI for ulcer, terlipressin + IV co-trimoxazole in variceal bleeds)
Treat possible clotting abnormalities
- IV Vit K
- FFP/cryoprecipitate
- Berriplex (if on warfarin)
- Platelets
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8
Q

which cannula is used?

A

purple

large bore

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9
Q

what is the Blatchford score?

A

stages severity of bleed

only score of 0 or 1 can go home

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10
Q

oesophageal cancer picture?

A
progressive dysphagia to solids then liquids (slow growing tumour)
appetite loss
weight loss
iron deficiency anaemia
odynophagia (pain on swallowing)
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11
Q

what is palliative treatment for oesophageal cancer?

A

stent

allows patient to eat and drink

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12
Q

what is the most likely cause of iron deficiency anaemia in over 50s?

A

oesophageal cancer

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13
Q

where is a Mallory Weiss tear likely to occur?

A

gastro-oesophageal junction

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14
Q

cause of GI bleeding in people with joint pain?

A

ulcer

as likely to take many painkillers

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15
Q

what is a gold probe?

A

heat coagulation

often occurs with injection of adrenaline

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16
Q

what are clips used for?

A

Mallory Weiss tear

visible vessel

17
Q

what is APC?

A

argon plasma coagulation

used in GAVE, oozing bleeding not active

18
Q

Liver disease + massive GI bleed?

A

oesophageal varices

19
Q

what is banding used for?

A

oesophageal varices (not gastric)

20
Q

what predicts sever upper GI bleed?

A

pulse of 110
liver disease
postural BP drop

21
Q

jaundice, spider naevi, ascites, haematamesis, malaena?

A

oesophageal varices

22
Q

what causes portal hypertension

A

pressure gradient between hepatic and portal vein rises above 10-12 so blood backs up into colaterals

23
Q

what are some possible collaterals in portal hypertension?

A

oesophagus
spleen
rectum

24
Q

if someone is having massive bleed?

A

massive haemorrhage protocol

25
Q

medium bleed?

A

O negative blood

26
Q

small bleed?

A

Alba

dextrose

27
Q

what medication given?

A

septrin (co-trimoxazole)

28
Q

INR>2?

A

IV Vit K

29
Q

spots of blood on oesophageal varices (Nickel sign?)

A

banding

30
Q

oesophageal varices > banding > bleed stops > rebleed, what next?

A

Recuss

Insert C sengstaken blakemore tube and inflate balloon to stabilise bleed before TIPS can be performed

31
Q

oesophageal varices > banding > bleed stops > rebleed, what next?

A

Recuss

Insert C sengstaken blakemore tube and inflate balloon to stabilise bleed before TIPS can be performed