Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

A - MSRA Gastrointestinal [7] > [32] Upper GI Bleeding > Flashcards

[32] Upper GI Bleeding Flashcards

1
Q

What is it important to know in the history in a patient with a upper GI bleed?

A 
Previous bleeds
Dyspepsia or known ulcers
Liver disease, or oesophageal varices
Dysphagia or weight loss
Drugs and alcohol
Co-morbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What may be found on examination in upper GI bleeding?

A

Signs of CLD

Signs of shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What signs of shock might be seen on examination in upper GI bleeding?

A 
Cool and clammy
CRT >2s
Decreased BP or postural hypotension
Decreased urine output
Tachycardia
Decreased GCS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What might be found on PR in upper GI bleeding?

A

Melaena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the common causes of upper GI bleeding, in order

A 
PUD
Acute erosions/gastritis 
Mallory-Weiss tear
Varices
Oesophagitis
Cancer of stomach or oesophagus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What kind of PUD more commonly causes upper GI bleeding?

A

DU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the purpose of a Rockall score?

A

Prediction of re-bleeding and mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What % of re-bleeders die in upper GI bleeds?

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the components to the Rockall score?

A

Initial

Final

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When is the initial Rockall score calculated?

A

Before endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is the final Rockall score calculated?

A

After endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is taken into account in the initial Rockall score?

A

Age
Shock - BP and pulse
Co-morbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is taken into account in the final Rockall score?

A

Final diagnosis, and evidence of recent haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What evidence for recent haemorrhage might be seen on endoscopy?

A

Active bleeding
Visible vessel
Adherent clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How can the Rockall score be used to guide surgery?

A

Initial score of 3 or more, or final score of 6 or more are indications for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the pathophysiology of oesophageal varices?

A

Portal hypertension leads to dilated veins at the sites of porto-systemic anastomosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What veins are affected in oesophageal varices?

A

Left gastric

Inferior oesophageal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What % of those with portal hypertension with bleed from varices?

A

30-50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the overall mortality of oesophageal varices?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the mortality from oesophageal varices dependant on?

A

The severity of liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the categories of causes of portal hypertension?

A

Pre-hepatic
Hepatic
Post-hepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the pre-hepatic causes of portal hypertension?

A

Portal vein thrombosis

23
Q

What are the hepatic causes of portal hypertension?

A

Cirrhosis
Schistosomiasis
Sarcoidosis

24
Q

What % of cases of portal hypertension are due to cirrhosis in the UK?

A

80%

25
Q

What are the post-hepatic causes of portal hypertension?

A

Budd-Chiari
RHF
Constrictive pericarditis

26
Q

What is first line in preventing bleeding from oesophageal varices?

A

Beta-blockers

Endoscopic banding

27
Q

What is second line in preventing bleeding from oesophageal varices?

A

Beta-blockers
Endoscopic banding
TIPSS (transjugular intrahepatic porto-sytemic shunt)

28
Q

What happens in TIPSS?

A

Interventional radiology create an artificial channel between the hepatic vein and portal vein, causing a decrease in portal pressure

29
Q

How is an artificial channel between the hepatic vein and portal vein created in TIPSS?

A

Colapinto needle creates a tract through the liver parenchyma, which is expanded using a balloon and maintained by placement of a stent

30
Q

What is the role of TIPSS in oesophageal varices?

A

It can be used prophylactically, or acutely if endoscopic therapy fails to control variceal bleeding

31
Q

What are the steps in the management of upper GI bleeding?

A
  1. Resuscitate
  2. Blood if remains shocked
  3. Maintenance
  4. Urgent endoscopy
  5. Medications and monitoring
32
Q

What is involved in resuscitation in upper GI bleeding?

A

Keep head down
100% oxygen, protect airway
2x14G cannula, and IV crystalloid infusion up to 1L

Take bloods

33
Q

What bloods need to be taken during the resuscitate stage of upper GI bleeding?

A 
FBC 
U&E
LFTs
Clotting
Cross match 6 units
ABG
Glucose
34
Q

What additional step should be taken after resuscitate and giving blood in variceal bleeding?

A

Terlipressin IV

Prophylactic antibiotics

35
Q

What is terlipressin?

A

A splanchnic vasopressor

36
Q

What prophylactic antibiotic might be given in variceal bleeds?

A

Ciprofloxacin 1g/24hours

37
Q

What is involved in maintenance management in upper GI bleeding?

A 
Crystalloid IVI, with blood transfusion if necessary
Catheter
Consider CVP
Correct coagulopathy
Thiamine if alcoholic
Notify surgeons of severe bleeds
38
Q

What Hb should be aimed for in the maintenance stage of upper GI bleeding management?

A

100 or above

39
Q

What CVP should be aimed for in the maintenance stage of upper GI bleeding management?

A

> 5cm H2O

40
Q

How can coagulopathy be corrected in upper GI bleeding management?

A

Vitamin K
FFP
Platelets

41
Q

What are the options for achieving haemostasis of a vessel or ulcer in upper GI bleeding?

A

Adrenaline injection
Thermal/laser coagulation
Fibrin glue
Endoclips

42
Q

What are the options for stopping variceal bleeding

A

2 of banding, sclerotherapy, adrenaline, and coagulation
Balloon tamponade
TIPSS

43
Q

What equipment is used for balloon tamponade in variceal bleeding?

A

Sengstaken-Blakemore tube

44
Q

When is balloon tamponade used in variceal bleeding?

A

Only when exsanguinating haemorrhage or failure of endoscopic therapy

45
Q

When is TIPSS used in variceal bleeding?

A

Only if bleeding can’t be stopped endoscopically

46
Q

What management is required for upper GI bleeding after endoscopy?

A 
Omeprazole IV and continuation of PO 
Keep NBM for 24 hours
Daily bloods
H. Pylori testing and eradication
Stop NSAIDs, steroids etc
47
Q

Why should omeprazole IV be given in upper GI bleeding?

A

Reduces the risk of rebleeding

48
Q

What should happen after patients with upper GI bleeding have been kept NBM for 24 hours?

A

Transition to clear fluids, then light diet at 48 hours

49
Q

What daily bloods need to be done after upper GI bleeding?

A

FBC
U&E
LFT
Clotting

50
Q

What are the indications for surgery in upper GI bleeding?

A

Re-bleeding
Bleeding despite transfusing 6u
Uncontrollable bleeding at endoscopy
Initial Rockall score >3, or final >6

51
Q

How is surgery for upper GI bleeding performed?

A

Open stomach, find bleeder, and underrun vessel

52
Q

Why should normal saline be avoided in uncompensated liver disease?

A

It worsens ascites

53
Q

What should be used instead of saline in uncompensated liver disease?

A

Blood or albumin for resus, and 5% dex for maintenance

A - MSRA Gastrointestinal [7] (44 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions