UpperGI- Bleeding Flashcards
What is haematemesis and malaena?
- Haematemesis- Vomiting blood
- Malaena- dark sticky blood consisting of partly digested blood, maybe due to internal bleeding.
With regards to ABC, what interventions are important in a haemorrhage?
Airway protection
Oxygen
IV access
fluids
What is the “100 rule” when it comes to assessing severity of haemorrhage?
- Systolic BP <100mmHg
- Pulse > 100/min
- Hb <100g/l
- Age > 60
- Commorbid disease
- Postural hypotension
What immediate investigation is undertaken following resuscitating a haemorrhagic patient?
Endoscopy
What phyiscal features in endoscopy can suggest a haemorrhage?
- Active bleeding/oozing
- Clot formation
- Visible vessel
What are the treatment options for peptic uclers?
- Endoscopic treatment
- Acid suppression by drugs
- Surgery
- H. pylori eradication
What are the subtypes of endoscopic treatment for bleeding ulcers?
- Injection
- Heater probe coagulations
- Combinations
- Clips
- Haemospray
What is injected in patients with endoscopic treatments?
Adrenaline
How does a haemospray work?
Haemospray contains a powder. When in contact with the blood, it absorbs the water then forms a protective barrier over the bleeding site.
Which drug is 1st line for acid suppression in bleeding?
IV Omeprazole
If endoscopic treatment followed by acid inhibition fails to stop and prevent further bleeding, what is the next treatment option?
Surgery
Define oesophageal Varises?
Dilated veins of the oesophagus
What condition is the biggest risk factor for Variceal bleeding?
Liver Cirrhosis
What is the pathogenesis of Variceal bleeding?
- Liver disease- Cirrhosis
- Portal hypertension
- Backflow of blood into oesophageal veins
- Oesophageal veins anastamose together
- Pooling of blood around oesophagus
- Increased blood causes veins to dilate
- Eventually they burst- Rupture
What conditions in the history can suggest variceal bleeding?
- Known cirrhosis
- Chronic alcohol ecxess
- Viral hepatitis infection
- Metabolic/autoimmune liver disease
- Intrabdominal sepsis
What investigations and things need to be considered before treating variceal bleeding?
- Coagulopathy (FFP/Platelets/ Vitamin K)
- Central venous pressure
- Parenteral vitamins
- Hypoglycaemia.
1st line drug intervention for Variceal bleeding?
Terlipressin- Splanchnic vasoconstrictor. Also has beneficiary effect on renal perfusion
What is endoscopic variceal ligation?
Wrapping a rubber band around the varices using an endoscope. Reduces bleeding.
What is sclerotherapy
Injection of an irritant that causes inflammaiton–> coagualtion of blood–> narrowing of the blood vessel wall.
What is the application of the Sengstaken-Blakemore tube?
In endoscopy a plastic tube inserted with it which deploys a balloon stent which inflates in the stomach. This compresses the gastro-oesophageal junction, reducing blood flow to the oesophageal varices.
How does TIPPS help in variceal bleeding?
Stent is deployed into a liver vein. The inflated stent forms a channel or shunt that bypasses the liver. This reduces portal hypertension, reducing chances of variceal bleeding and rupture.
