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#Phase 2.1: Peri Op > Upper + Lower GI Bleed > Flashcards

Upper + Lower GI Bleed Flashcards

1
Q

What are the risk factors for GI bleeds? (5 things)

A
  1. H pylori infection
  2. NSAIDs
  3. Alcohol
  4. Cirrhosis
  5. Vasc disease
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2
Q

What are the organs that are involved in UPPER GI bleeds? (3 things)

A
  1. Oesophagus
  2. Stomach
  3. Duodenum
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3
Q

What are the Oesophageal causes for UPPER GI bleeds? (4 things)

A
  1. Oesophageal Varices
  2. Oesophageal Infection / inflamm
  3. Oesophageal Cancer
  4. Mallory-Weiss tear: tear in oesophageal lining bc forceful vomiting
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4
Q

What are the Stomach causes for UPPER GI bleeds? (5 things)

A
  1. Gastric ulcer
  2. Erosive gastritis
  3. Portal HTN gastropathy
  4. Dieulafoy lesion: large vessel that erodes + bleeds
  5. Angiodysplasia: abn. collection of blood vessels
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5
Q

What are the Duodenum causes for UPPER GI bleeds? (3 things)

A
  1. Duodenal ulcer
  2. Angiodysplasia: abn. collection of blood vessels
  3. Aortoenteric fistula (rare)
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6
Q

What are the types of causes involved in LOWER GI bleeds? (5 things)

A
  1. Diverticular disease
  2. Inflamm disease
  3. Cancer
  4. Trauma / Iatrogenic
  5. Vascular disease
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7
Q

What are the diverticular diseases that can cause LOWER GI bleeds? (3 things)

A
  1. Diverticulosis
  2. Diverticulitis
  3. Meckel’s diverticulum: congenital outpouching in ileum
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8
Q

What are the vascular diseases that can cause LOWER GI bleeds? (3 things)

A
  1. Angiodysplasia
  2. Ischaemia (mesenteric ischaemia / ischaemic colitis)
  3. Haemorrhoids: venous structures of anorectum that engorge –> prolapse –> bleed
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9
Q

What is the trauma that can cause LOWER GI bleeds?

A

Anal fissure: small tear in anal mucosa

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10
Q

What are the neoplasms that can cause LOWER GI bleeds? (2 things)

A
  1. Colon polyp

2. Colorectal cancer

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11
Q

What are the inflammatory diseases that can cause LOWER GI bleeds? (2 things)

A
  1. Infectious colitis

2. Ulcerative colitis + Crohn’s disease (AI inflamm. bowel disease –> cause inflammation + ulcers)

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12
Q

What are the iatrogenic causes that can cause LOWER GI bleeds? (3 things)

A
  1. Biopsy / polypectomy
  2. Radiation colitis (radiation induced colon inflamm)
  3. Aortoenteric fistula
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13
Q

What are the possible CF of a GI bleed? (11 things)

A
  1. Shock
  2. Anaemia symptoms
  3. Coffee ground emesis (upper GI)
  4. Haematemesis (upper GI)
  5. Heartburn / Abd pain / tenderness (gastritis / ulcers / ischaemia)
  6. Chronic liver disease signs
  7. Melena
  8. Haematochezia (bright red bloody stools) (lower GI / large volume upper GI)
  9. Rectal mass
  10. Anal fissure
  11. Weight loss (Cancer)
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14
Q

What are the signs of Chronic liver disease (seen in clinical examination of patient with GI bleed) ? (4 things)

A
  1. Ascites
  2. Spider nevus (abn collection of blood vessels @ skin surface)
  3. Splenomegaly
  4. Asterixis (hand tremor @ wrist extended)
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15
Q

What lab tests should be done for patients with suspected GI bleed? (6 things)

A
  1. FBC (anaemia)
    - Hb initially normal in acute
    - Thrombocytopenia @ cirrhosis
  2. FIT (Faecal Immunological Test) / FOB (Faecal Occult Blood) test (detect invisible blood in poo)
  3. Coag factors (coagulopathy)
  4. LFTs (underlying liver disease)
  5. Blood Urea Nitrogen (BUN) test (high = upper GI)
  6. Iron / ferritin (iron def.)
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16
Q

What imaging can be used to detect ACTIVE bleeding in a patient?

A

CT abdomen w contrast

17
Q

What is the gold standard procedure for diagnosing UPPER GI bleeds?

A

Oesophago-gastro-duodenoscopy (OGD)

18
Q

What is the purpose of an OGD in upper GI bleeds? (3 things)

A
  1. Visualise site of bleeding @ oesophagus / stomach / duodenum
  2. Collect pathology specimens
  3. Stop bleed
19
Q

What is the gold standard procedure for diagnosing LOWER GI bleeds?

A

Colonscopy

20
Q

What is the purpose of colonoscopy in LOWER GI bleeds? (2 things)

A
  1. Visualise site of bleeding @ large intestine / terminal ileum
  2. Collect pathology specimens
21
Q

What investigation should be used for a patient with suspected GI bleed with intermittent bleeding and their OGD and colonoscopy results are unremarkable?

A

Capsule endoscopy

Provides imaging of small intestine

22
Q

What investigation should be done for a patient with suspected GI bleed who cannot undergo endoscopy bc haemodynamic instability?

A

Angiography

23
Q

How do you manage a patient with a GI bleed initially? (5 things)

A
  1. Airway (intubate if severe haematemesis)
  2. Oxygen
  3. IV Fluids (resus)
  4. G&S
  5. Blood transfusion (with cross matched blood)
24
Q

What medications can you give a patient with a GI bleed? (2 things)

A
  1. PPI (pantoprazole, better than omeprazole in GI bleeds)

2. Octreotide (somatostatin analog –> splanchnic aka abd organs vasoconstriction) (for oesophageal bleeds)

25
Q

What percentage of GI bleeds will resolve without intervention?

A

80%

26
Q

What intervention can be done using OGD / colonscopy for GI bleed? (5 things)

A
  1. Inject Adrenaline + Sclerosant
  2. Elastic band ligation
  3. Thermal haemostasis
  4. Endoclips
  5. Balloon tamponade (temporary before above definitve)
27
Q

What intervention can be done using angiography for GI bleed? (2 things)

A
  1. Vasopressin (–> vasoconstriction)

2. Embolization

28
Q

What is the risk of doing an angiography for a GI bleed

A

Bowel ischemia / infarction

29
Q

What is the balloon tamponade intervention method for a GI bleed? (3 things)

A

For oesophageal varices

  1. Tube inserted into oesophagus
  2. Balloon inflated
  3. Prov short term haemostasis until definitive treatment arranged
30
Q

When should surgery be considered for a GI bleed?

A

When bleeding can’t be contained by other interventions

31
Q

What is important you do before doing surgery for a GI bleed?

A

Localising source of bleed

32
Q

What should patients with cirrhosis and variceal bleeding be given?

A

Abx prophylaxis to prevent bac peritonitis

33
Q

What should be done with a hypertensive patient with a GI bleed?

A

Stop antihypertensive meds

#Phase 2.1: Peri Op (24 decks)

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