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Alimentary Block > Week 4.6 - Acute Gastrointestinal Bleeding > Flashcards

Week 4.6 - Acute Gastrointestinal Bleeding Flashcards

1
Q

What splits upper GI bleeding from lower GI bleeding?

A

ligament of trietz - between greater stomach curvature and duodenum.

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2
Q

What does upper GI bleeding present with?

A
  • melena,
  • haematemesis,
  • elevated urea (blood digested to protein),
  • dyspepsia,
  • reflux,
  • epigastric pain,
  • NSAID use
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3
Q

What does lower GI bleeding present with?

A
  • fresh blood per rectum
  • magenta stools (dark purple right colon/higher)
  • normal urea - no blood digestion
  • painless
  • old age
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4
Q

What are upper GI causes of acute bleeding?

A

oesophageal - ulcer, itis, varices, malignancy, mallory weiss
gastric - ulcer, itis, malignancy, varices
duodenal - ulcer, itis

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5
Q

What are the top most common causes of acute upper GI bleeding?

A

75% peptic ulcers, then gastritis, oesophagitis and duodenitis, varices

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6
Q

What is zollinger-ellison syndrome?

A

tumour in pancreas producing lots of gastrin, causing excess acid production, causing recurrent gastric ulcers

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7
Q

When do gastritis and duodenitis tend to bleed?

A

in the case of taking anti-coagulants or anti-platelets. low risk of death

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8
Q

What is mallory weiss tear?

A

linear tear at gastro-oesophageal junction due to excess retching. vomit with blood

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9
Q

What is Dieulafoy?

A

vascular malformation causing bleeding from arteriole. rare

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10
Q

What is angiodysplasia?

A

can occur in upper or lower GI. abnormal dilated vessels oozing in mucosa and submucosa.

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11
Q

What is diverticular disease?

A

bulges or outpocketings in the intestine. diverticulosis is presence. diverticulitis is inflammation. may bleed and recurence rate is high.

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12
Q

What are the most common causes of acute lower GI bleeds?

A
  • most commonly haemorrhoids and diverticular disease.
  • also vascular malformations.
  • neoplasia,
  • ischaemic colitis,
  • IBD,
  • radiation colitis
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13
Q

What are haemorrhoids?

A

vascular cushions around anal canal. if inside and small not painful - painless bleeding. if outside and large then very painful. treat with topical steroids

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14
Q

How does ischaemic colitis cause acute GI bleed?

A

disrupts blood supply, causing congestion. abdominal pain, bloody stool. usually old. usually self limiting.

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15
Q

What is radiation proctitis?

A

acute OR chronic inflammation affecting maybe after 1-2 years of RT for cancer. may b treated with APC if not so severe

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16
Q

When would you use a CT angiography?

A

effective if bleeding is severe at significant speed so can be viewed.

17
Q

What is APC?

A

argon plasma coagulation - heat treatment for angiodysplasia vessels or not very severe radiation proctitis. burns vessels to stop bleeding.

18
Q

What is mackels scan scintigraphy?

A

mackels is when gastric mucosa grows in small bowel - produces acid and causes ulcers and bleeding. diagnoses this by detecting mucosa.

19
Q

What are the 6 steps in the management of Gi bleeding?

A
  1. resuscitation
  2. risk stratification
  3. diagnosis and treatment
  4. any medications we should stop worsening it?
  5. Try PPI’s and tranexamic acid
  6. consider CT angiography, other radiology or surgical interventions
20
Q

How do we carry out risk stratification?

A
  • rockall and blatchford score for upper GI bleeding.
  • looks at age, co-morbidities, shock.
  • determines if we keep patient or put in critical care
21
Q

What diagnosis and treatment do we do for upper and lower acute GI bleeding?

A

upper GI - endoscopy and therapeutic if needed. ensure they’re stable.
lower GI - colonoscopy or CT angiogram if lot of bleeding

22
Q

What medicines may be contributory to acute GI bleeding and how do we manage this?

A
  • take patients off anti-coagulants, anti-platelets, possibly reverse them.
  • reintroduce after patients stable as many patients die from co-morbidity they were taking the medication for.
23
Q

What is the purpose of taking PPI’s and tranexamic acid?

A
  • PPI helps ulcers heals.
  • tranexamic acid makes blood more sticky and reduces bleeding
24
Q

How do we manage bleeding from varices?

A
  • do band ligation for oesophageal varices, or glue injection for oesophageal, gastric or rectal varices.
  • if ineffective give terlipressin - vasoconstrictor of splanchnic blood supply to reduce portal hypertension
  • give TIPS as porto-systemic shunt
25
Q

How do we reduce bleeding from a peptic ulcer?

A
  • commonly give adrenaline injection to vasoconstrict area.
  • gold probe heat treatment
  • clip - staple vessel
  • PPI’s - reduce acid and let ulcer heal

Alimentary Block (38 decks)

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