Upper + Lower GI Bleed Flashcards
What are the risk factors for GI bleeds? (5 things)
- H pylori infection
- NSAIDs
- Alcohol
- Cirrhosis
- Vasc disease
What are the organs that are involved in UPPER GI bleeds? (3 things)
- Oesophagus
- Stomach
- Duodenum
What are the Oesophageal causes for UPPER GI bleeds? (4 things)
- Oesophageal Varices
- Oesophageal Infection / inflamm
- Oesophageal Cancer
- Mallory-Weiss tear: tear in oesophageal lining bc forceful vomiting
What are the Stomach causes for UPPER GI bleeds? (5 things)
- Gastric ulcer
- Erosive gastritis
- Portal HTN gastropathy
- Dieulafoy lesion: large vessel that erodes + bleeds
- Angiodysplasia: abn. collection of blood vessels
What are the Duodenum causes for UPPER GI bleeds? (3 things)
- Duodenal ulcer
- Angiodysplasia: abn. collection of blood vessels
- Aortoenteric fistula (rare)
What are the types of causes involved in LOWER GI bleeds? (5 things)
- Diverticular disease
- Inflamm disease
- Cancer
- Trauma / Iatrogenic
- Vascular disease
What are the diverticular diseases that can cause LOWER GI bleeds? (3 things)
- Diverticulosis
- Diverticulitis
- Meckel’s diverticulum: congenital outpouching in ileum
What are the vascular diseases that can cause LOWER GI bleeds? (3 things)
- Angiodysplasia
- Ischaemia (mesenteric ischaemia / ischaemic colitis)
- Haemorrhoids: venous structures of anorectum that engorge –> prolapse –> bleed
What is the trauma that can cause LOWER GI bleeds?
Anal fissure: small tear in anal mucosa
What are the neoplasms that can cause LOWER GI bleeds? (2 things)
- Colon polyp
2. Colorectal cancer
What are the inflammatory diseases that can cause LOWER GI bleeds? (2 things)
- Infectious colitis
2. Ulcerative colitis + Crohn’s disease (AI inflamm. bowel disease –> cause inflammation + ulcers)
What are the iatrogenic causes that can cause LOWER GI bleeds? (3 things)
- Biopsy / polypectomy
- Radiation colitis (radiation induced colon inflamm)
- Aortoenteric fistula
What are the possible CF of a GI bleed? (11 things)
- Shock
- Anaemia symptoms
- Coffee ground emesis (upper GI)
- Haematemesis (upper GI)
- Heartburn / Abd pain / tenderness (gastritis / ulcers / ischaemia)
- Chronic liver disease signs
- Melena
- Haematochezia (bright red bloody stools) (lower GI / large volume upper GI)
- Rectal mass
- Anal fissure
- Weight loss (Cancer)
What are the signs of Chronic liver disease (seen in clinical examination of patient with GI bleed) ? (4 things)
- Ascites
- Spider nevus (abn collection of blood vessels @ skin surface)
- Splenomegaly
- Asterixis (hand tremor @ wrist extended)
What lab tests should be done for patients with suspected GI bleed? (6 things)
- FBC (anaemia)
- Hb initially normal in acute
- Thrombocytopenia @ cirrhosis - FIT (Faecal Immunological Test) / FOB (Faecal Occult Blood) test (detect invisible blood in poo)
- Coag factors (coagulopathy)
- LFTs (underlying liver disease)
- Blood Urea Nitrogen (BUN) test (high = upper GI)
- Iron / ferritin (iron def.)
What imaging can be used to detect ACTIVE bleeding in a patient?
CT abdomen w contrast
What is the gold standard procedure for diagnosing UPPER GI bleeds?
Oesophago-gastro-duodenoscopy (OGD)
What is the purpose of an OGD in upper GI bleeds? (3 things)
- Visualise site of bleeding @ oesophagus / stomach / duodenum
- Collect pathology specimens
- Stop bleed
What is the gold standard procedure for diagnosing LOWER GI bleeds?
Colonscopy
What is the purpose of colonoscopy in LOWER GI bleeds? (2 things)
- Visualise site of bleeding @ large intestine / terminal ileum
- Collect pathology specimens
What investigation should be used for a patient with suspected GI bleed with intermittent bleeding and their OGD and colonoscopy results are unremarkable?
Capsule endoscopy
Provides imaging of small intestine
What investigation should be done for a patient with suspected GI bleed who cannot undergo endoscopy bc haemodynamic instability?
Angiography
How do you manage a patient with a GI bleed initially? (5 things)
- Airway (intubate if severe haematemesis)
- Oxygen
- IV Fluids (resus)
- G&S
- Blood transfusion (with cross matched blood)
What medications can you give a patient with a GI bleed? (2 things)
- PPI (pantoprazole, better than omeprazole in GI bleeds)
2. Octreotide (somatostatin analog –> splanchnic aka abd organs vasoconstriction) (for oesophageal bleeds)
What percentage of GI bleeds will resolve without intervention?
80%
What intervention can be done using OGD / colonscopy for GI bleed? (5 things)
- Inject Adrenaline + Sclerosant
- Elastic band ligation
- Thermal haemostasis
- Endoclips
- Balloon tamponade (temporary before above definitve)
What intervention can be done using angiography for GI bleed? (2 things)
- Vasopressin (–> vasoconstriction)
2. Embolization
What is the risk of doing an angiography for a GI bleed
Bowel ischemia / infarction
What is the balloon tamponade intervention method for a GI bleed? (3 things)
For oesophageal varices
- Tube inserted into oesophagus
- Balloon inflated
- Prov short term haemostasis until definitive treatment arranged
When should surgery be considered for a GI bleed?
When bleeding can’t be contained by other interventions
What is important you do before doing surgery for a GI bleed?
Localising source of bleed
What should patients with cirrhosis and variceal bleeding be given?
Abx prophylaxis to prevent bac peritonitis
What should be done with a hypertensive patient with a GI bleed?
Stop antihypertensive meds
