Acute gastro-intestinal bleed

Question 1

What is the definition of a GI bleed?

Answer 1

A bleed anywhere from the mouth to the anus, can be upper or lower

Question 2

What is the pathology of a GI bleed?

Answer 2

• Breakdown in gastric mucosa
• Vomiting tears mucosa in Mallory Weiss syndrome
• NSAIDs affect mucosal/bicarbonate production – no protection to mucosa

Question 3

What are the causes and risk factors of GI bleeds?

Answer 3

• Peptic ulcer – most common cause
• Drugs - NSAIDs
• Alcohol
• Gastric varices
• Reflux oesophagitis
• Mallory Weiss syndrome – tear in the mucosal membrane where the oesophagus meets the stomach

Question 4

What are the signs and symptoms of a GI bleed?

Answer 4

• Melena
• Haematemesis – vomiting out blood
• Shock

Question 5

What investigations are conducted when suspecting a GI bleed?

Answer 5

• Pulse and BP – every 30 mins
• Bloods – Hb, U&E’s, LFT’s, coagulation screen, group and crossmatch
• Endoscopy – if shocked
• Rockall score – assesses risk of rebleeding and death
• Blatchford score – determines the need for blood transfusion or endoscopy

Question 6

What are the surgical treatments for GI bleeds?

Answer 6

• Varies treated by banding
• Stenting to treat varices also
• Endoscopic clipping
• Embolization

Question 7

What are the pharmacological treatments for a GI bleed?

Answer 7

• Injection with adrenaline
• Thermal coagulation – heater probe, bipolar probe, laser/argon plasma coagulation
• Hemostatic powders – for more difficult bleeds
• IV PPI (80mg omeprazole followed by infusion)
• H. pylori eradication therapy [see peptic ulcers]

Question 8

What are the non pharmacological treatments for a GI bleed?

Answer 8

• Let it stop on its own
• Transfusion – for massive bleeds
• Stop antiplatelet, anticoagulants and NSAIDs
• Oxygen
• Fluids
• Nil by mouth – until endoscopy has been performed