Gastrointestinal Haemmorhage

Question 1

What are the symptoms of GI bleeding?

Answer 1

Haematemesis
Malaena
Haematochezia
Abdominal pain

Question 2

What are the signs of GI bleeding?

Answer 2

Underlying cause

Shock

Question 3

What are the specific symptoms/signs of chronic GI bleeding?

Answer 3

Iron deficient anaemia

Question 4

What are the common causes of GI bleeding?

Answer 4

Peptic ulceration (40%)
Gastroduodenal erosions (15%)
Oesophagitis (15%)
Mallory-Weiss syndrome (15%)
Varices (10%)
Upper GI malignancy

Question 5

What is Mallory-Weiss syndrome?

Answer 5

Tears at gastro-oesophageal junction due to violent vomiting

Question 6

What is the initial management of a pt w/ GI haemorrhage?

Answer 6

Manage as per haemorrhagic shock (Hb >8)
Assess using Glasgow-Blatchford score
Endoscopy w/i 4hrs (if indicated)
IV Omeprazole (80mg stat then 8mg/hr for 72hrs)
High level of monitoring
Definitive laparotomy/angiographic embolisation

Question 7

What is the Glasgow-Blatchford score?

Answer 7

Scoring system including
   -SBP
   -pulse
   -Hb
   -blood urea level
   -melaena
   -syncope
   -hepatic/cardiac disease
Score >6 indicates mortality >50%

Question 8

What are the indications for definitive laparotomy/angiographic embolisation?

Answer 8

Bleeding recurring after endoscopy
Bleeding persistent despite endoscopic
Bleeding torrential/obscuring embolisation

Question 9

What is the Rockall score?

Answer 9

Screening tool that includes endoscopy findings

Can give an estimate of mortality in upper GI bleeds