Acute Gastrointestinal Haemorrhage Flashcards Preview

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Flashcards in Acute Gastrointestinal Haemorrhage Deck (12):
1

Which type of GI bleeds are more common?

Upper

4x more common than lower

2

Common causes of GI bleeding:

* Peptic ulcer (most common)
* Oesophageal varices
* Mallory-Weiss tear
* Gastritis/gastric erosions
* Oesophagitis
* Duodenitis
* Drugs
NSAIDs
Aspirin
Steroids
Thrombolytics
Anticoagulants
* Malignancy

3

Rarer causes of GI bleeding:

* Coagulopathies
* Portal hypertensive gastropathy
* Aorto-enteric fistula
* Angiodysplasia
* Haemobilia
* Dieulafoy lesion
* Peutz-Jegher's syndrome
* Osler-Weber-Rendu syndrome (HHS)

4

Symptoms of GI bleed:

* Abdo pain (epigastric/diffuse)
* Haematemesis (bright red/coffee grounds)
* Melaena
* Syncope/presyncope
* Shock
* Retching (?MV tear)

5

Signs of GI bleed:

* Pallor
* Tachycardia
* Hypotension
* Tachypnoea
* Postural hypotension
* Cool extremities
* Chest pain
* Confusion/delerium
* Oliguria
* Stigmata of hepatic disease
* Meleana on PR exam

6

Investigations for suspected UGI bleed:

1. Endoscopy (immediately after resus if unstable, <24h if stable)

2. Bloods (FBC, Xmatch, coagulation, LFTs, U&Es)

3. Imaging: CXR, AXR, CT

7

What features in the bloods would suggest GI bleed?

Anaemia (but initially Hb may be normal as haemodilution has not et occurred)

Increased urea:Cr ratio (suggests massive blood meal to the GIT)

8

Acute management of upper GI bleed:

A: Protect airway. NBM

B: Give 15L/min O2. Request CXR & ABG

C: 2x large-bore cannulas. Bloods. IV fluids. O- blood whilst awaiting Xmatch if required. Urinary catheter. ECG

* Consider CVP monitoring

* Transfuse if Hb <70

* Correct clotting abnormalities

* If suspected varices give Terlipressin

* Arrange urgent endoscopy for Rx.

9

What should be done if endoscopic control of GI bleed fails?

* Surgery
* Emergency mesenteric angiography/embolisation
* Sengstaken-Blakemore tube (varices)

10

Complications of endoscopic intervention:

* Aspiration pneumonia
* Perforation

11

Complications of transfusion in GI bleed:

* Transfusion reactions (TRALI, TRGvHD, Acute haemolytic)

* Circulatory overload (TACO)

* Dilution coagulopathy

* Metabolic acidosis (citrate)

* Hypothermia

12

What scoring system predicts mortality in upper GI bleed?

Rockall score

<3 = excellent prognosis

>8 = high mortality