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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
What percentage of GI bleeds will resolve without intervention?
80%
26
What intervention can be done using OGD / colonscopy for GI bleed? (5 things)
1. Inject Adrenaline + Sclerosant 2. Elastic band ligation 3. Thermal haemostasis 4. Endoclips 5. Balloon tamponade (temporary before above definitve)
27
What intervention can be done using angiography for GI bleed? (2 things)
1. Vasopressin (--> vasoconstriction) | 2. Embolization
28
What is the risk of doing an angiography for a GI bleed
Bowel ischemia / infarction
29
What is the balloon tamponade intervention method for a GI bleed? (3 things)
For oesophageal varices 1. Tube inserted into oesophagus 2. Balloon inflated 3. Prov short term haemostasis until definitive treatment arranged
30
When should surgery be considered for a GI bleed?
When bleeding can't be contained by other interventions
31
What is important you do before doing surgery for a GI bleed?
Localising source of bleed
32
What should patients with cirrhosis and variceal bleeding be given?
Abx prophylaxis to prevent bac peritonitis
33
What should be done with a hypertensive patient with a GI bleed?
Stop antihypertensive meds

#Phase 2.1: Peri Op (24 decks)

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