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Year Two - Gastroenterology System > Upper Gastrointestinal Bleeding > Flashcards

Upper Gastrointestinal Bleeding Flashcards

1
Q

What is upper gastrointestinal bleeding?

A

It refers to bleeding proximal to the ligament of Treitz, usually involving the oesophagus, stomach or duodenum

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2
Q

What are the four oesophageal causes of upper gastrointestinal bleeding?

A

Oesophageal Varices

Oesophagitis

Mallory Weiss Tear

Oesophageal Cancer

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3
Q

How do oesophageal variceal patients present?

A

Alcoholism

Chronic liver disease features

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4
Q

What is a Mallory Weiss tear?

A

It is defined as a tear of the oesophageal mucous membrane

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5
Q

What are the four gastric causes of upper gastrointestinal bleeding?

A

Peptic Ulceration

Gastritis

Dieulafoy Lesion

Gastric cancer

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6
Q

What is a duodenal cause of upper gastrointestinal bleeding?

A

Aorto-Enteric Fistula

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7
Q

What are the two most common causes of upper gastrointestinal bleeding?

A

Oesophageal varices

Peptic ulceration

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8
Q

What are the five clinical features associated with upper gastrointestinal bleeding?

A

Haematemesis

Melaena

Epigastric Pain

Hypotension

Tachycardia

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9
Q

What are the two appearances of haematemesis?

A

Fresh red blood

Coffee grounds

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10
Q

What is coffee ground haematemesis?

A

It is vomiting of digested blood

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11
Q

What is melaena?

A

It is tar-like, black, greasy and offensive stools

It is caused by the passing of digested blood in stools

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12
Q

What are the two scoring systems used in upper gastrointestinal bleeding?

A

Glasgow Blatchford Score

Rockall Score

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13
Q

When is the Glasgow Blatchford score used?

A

It is the initial scoring system used to risk assess suspected upper gastrointestinal bleeding

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14
Q

What is the function of the Glasgow Blatchford score?

A

It can be applied to determine a management plan

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15
Q

What Glasgow Batchford score suggests individuals are at high risk and should be hospitalised for further investigation?

A

> 0

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16
Q

What is the management option for individuals with a Blatchford score of 0?

A

Discharge with advice and outpatient follow up

17
Q

What are the eight criteria used in the Glasgow Blatchford score?

A

Urea (mmol/L)

Haemoglobin (g/L)

Systolic Blood Pressure (mmHg)

Heart Rate (bpm)

Melaena

Syncope

Hepatic Disease

Cardiac Failure

18
Q

Which blood test result indicates an upper gastrointestinal bleed rather than a lower gastrointestinal bleed?

A

Increased urea levels

19
Q

When is the Rockall score used?

A

It is the scoring system used to risk assess suspected upper gastrointestinal bleeding AFTER an endoscopy

20
Q

What is the function of the Rockall score?

A

It provides a percentage risk of rebleeding and mortality

21
Q

What are the five criteria of the Rockall score?

A

Age

Shock Features (Hypotension, Tachycardia)

Co-Morbidities

Bleeding Aetiology

Endoscopic Features

22
Q

What is the first line management option in upper gastrointestinal bleeding?

A

Resuscitation

23
Q

What are the five resuscitation steps in upper gastrointestinal bleeding?

A

ABCDE Approach

Wide-Bore Cannula Insertion x2

Blood Sampling

Blood Transfusion

Endoscopy

24
Q

What five blood tests should be conducted to investigate upper gastrointestinal bleeding?

A

Full Blood Count (Haemoglobin, Platelets)

Urea & Electrolytes (Urea)

Liver Function Tests

International Normalised Ratio

Group & Save

25
Q

What pneumonic can be used to remember the resuscitation steps of upper gastrointestinal bleeding?

A

ABATED

ABCDE management

Bloods

Access

Transfusion

Endoscopy

Drugs

26
Q

What is the change that occurs in haemoglobin levels with upper gastrointestinal bleeding?

A

Decrease

27
Q

What is the change that occurs in urea levels with upper gastrointestinal bleeding? Why?

A

Increase

The blood in the gastrointestinal tract is broken down by digestive enzymes

Urea is one of the breakdown products and is then absorbed in the intestines

28
Q

How soon after presentation of upper gastrointestinal bleeding should individuals receive an endoscopy?

A

Within 24 hours

29
Q

In which circumstance, is platelet transfusion recommended in upper gastrointestinal bleeding?

A

Platelets < 50 x 109/L

30
Q

In which circumstance, is fresh frozen plasma transfusion recommended in upper gastrointestinal bleeding?

A

Fibrinogen < 1g/L

OR

INR > x 1.5

31
Q

In which circumstance, is prothrombin complex concentrate transfusion recommended in upper gastrointestinal bleeding?

A

A warfarin patient who is actively bleeding

32
Q

How do we pharmacologically manage upper gastrointestinal bleeding?

A

We review medications and stop those that could precipitate bleeding

33
Q

Which four medications are stopped in upper gastrointestinal bleeding?

A

NSAIDs

Anti-Coagulants

Anti-Platelets

Tranexamic Acid

34
Q

Is it recommended to administer PPIs before endoscopy?

A

No

35
Q

In cases where the upper gastrointestinal bleeding is related to oesophageal varices, what are the two pharmacological management options?

A

Terlipressin

Prophylactic Broad Spectrum

36
Q

What is the mechanism of action of terlipressin?

A

It is a vasoconstrictor of splanchnic blood supply, which reduces blood flow to the portal vein and therefore portal hypertension

37
Q

In cases where the upper gastrointestinal bleeding is related to oesophageal varices, what are the two surgical management options?

A

Band Ligation

Transjugular Intrahepatic Portosystemic Shunts (TIPS)

Year Two - Gastroenterology System (33 decks)

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