Acute GI Bleeding Flashcards
(92 cards)
1
Q
What effects the outcome of acute GI bleeding?
A
Identifications and prompt management
2
Q
What is considered upper GI bleeding?
A
- Bleeding from the oesophagus, stomach or duodenum
- Proximal to ligament of Trietz
3
Q
What is considered lower GI bleeding?
A
- Bleeding distal to duodenum (jejunum, ileum, colon)
- Distal to ligament Trietz
4
Q
What can upper GI bleeding present as?
A
- Haematemesis
- Melaena
5
Q
Why is urea elevated in upper GI bleeding?
A
Partially digested blood>haem>urea
6
Q
What is upper GI bleeding associated with?
A
- Dyspepsia
- Reflux
- Epigastric pain
- NSAID use
7
Q
What can lower GI bleeding present as?
A
- Fresh blood/clots
- Magenta stools
- Typically painless
8
Q
When is lower GI bleeding more common?
A
In advanced age
9
Q
What are the possible sites of upper GI bleeding?
A
- Oesophagus
- Stomach
- Duodenum
10
Q
Where can ulcers occur?
A
All areas
11
Q
When do ‘itis’ conditions tend to bleed?
A
Tend to bleed in context of abnormal clotting
12
Q
What causes of upper GI bleeding can occur in the oesophagus?
A
- Oesophageal varices
- Mallory Weiss tear
- Oesophageal malignancy
13
Q
What causes of upper GI bleeding can occur in the stomach?
A
- Gastric varices
- Gastric malignancy
- Dieulafoy
- Angiodysplasia
14
Q
What cause of upper GI bleeding can occur in the duodenum?
A
Angiodysplasia
15
Q
What is the most common cause of acute upper GI bleed?
A
Ulcer
16
Q
What questions are useful in making a diagnosis for upper GI bleeding?
A
- Are you on any medications?
- Have you had any abdominal pain?
- Has there been any change in weight recently?
- What is your alcohol consumption per week?
- Do you take any painkillers?
17
Q
What is the most common GI ulcer?
A
Duodenal
18
Q
What are the risk factors for peptic ulcers?
A
- H pylori
- NSAIDs/aspirin
- Alcohol excess
- Systemic illness
19
Q
Why is H pylori a risk factor for peptic ulcers?
A
- Urease production
- Ammonia production
- Buffers gastric acid
- Increased acid production
20
Q
Why are NSAIDs and aspirin risk factors for peptic ulcers?
A
- Prostoglandin production
- Reduced mucus and bicarbonate excretion
- Reduced physical defences
21
Q
What does Zollinger-Ellison syndrome cause?
A
Recurrent poor healing duodenal ulcers
22
Q
What may gastric ulcers sit over?
A
- Gastric carcinoma
- Repeat endoscopy indicated at 8 weeks
23
Q
What impaired coagulation could lead to bleeding of gastritis and duodenitis?
A
- Medical conditions
- Anti-coagulants
- Anti-platelets
24
Q
When are you more likely to have significant bleeding with oesophagitis?
A
If on anti-platelets or anti-coagulation
25
What can cause oesophagitis?
- Reflux
- Hiatus hernia
- Alcohol
- Bisphosphonates
- Systemic illness
26
What are varices secondary to?
Portal hypertension usually due to liver cirrhosis
27
Varices
Abnormally dilated collateral vessels
28
What is the incidence of varices within the GIT?
- Oesophageal 90%
- Gastric 8%
- Rectal and splenic rare
29
What can lead to life threatening bleeding with varices?
Increases in portal pressure (due to infection, drug us etc)
30
What is there usually a history of with oesophageal cancer?
- Dysphagia
| - Weight loss
31
What is the typical character of bleeding due to oesophageal cancer?
Typically ooze
32
What other manifestation can gastric cancer present as?
Ulcer
33
What does GU require for healing?
Interval endoscopy for healing
34
What is a Mallory-Weiss tear?
Linear tear at oesophageal-gastric junction
35
What does a Mallory-Weiss tear usually follow?
Period of retching/vomiting
36
What is the outcome of a Mallory Weiss tear?
Up to 10% require endoscopic treatment
| -Most heal on their own
37
Diuelafoy
Submucosal arteriolar vessel eroding through mucosa
38
Where do diuelafoy occur?
Gastric fundus
39
What is angiodysplasia?
Vascular malformation
40
Where can angiodysplasia occur?
Anywhere in the GIT
41
What is angiodysplasia a frequent cause of?
Chronic occult or overt occult bleeding
42
What is angiodysplasia associated with?
Chronic conditions including heart valve replacement
43
What are colonic cause of lower GI bleeding?
- Diverticular disease
- Haemorrhoids
- Vascular malformations
- Neoplasia
- Ischaemic colitis
- Radiation enteropathy/proctitis
- Inflammatory bowel disease
44
What does the diagnosis of cause of lower GI bleeding require?
Flexible sigmoidoscopy or full colonoscopy
45
Diverticular disease?
Protrusion of the inner mucosal lining through the outer muscular layer forming a pouch
46
Diverticulosis
Presence of diverticular disease
47
Diverticulitis
Inflammation in diverticular disease
48
What is there a risk of with lower GI bleeding due to diverticular disease?
Further bleeding
49
What is the prognosis of bleeding due to diverticular disease?
Usually self limiting
50
Haemorrhoids
Enlarged vascular cushions around anal canal
51
When are haemorrhoids painful?
If thrombosed or external
52
What are haemorrhoids associated with?
Straining/constipation/low fibre diet
53
What is the treatment for haemorrhoids?
Elective surgical intervention
54
What may angiodysplasia be associated with?
Valvular abnormalities
55
What is bleeding due to angiodysplasia often precipitated by?
Anticoagulants/antiplatelets
56
What is the treatment for angiodysplasia?
Argon Phototherapy
57
What is included in colonic neoplasia?
Colonic polyps or carcinoma
58
Ischaemic colitis
Disruption in bloody supply to colon
59
What does ischaemic colitis affect areas according to?
Blood supply
60
What does ischaemic colitis present with?
Crampy abdominal pain
61
When is ischaemic colitis more commen?
Over 60 years of age
62
What is usually the outcome of bleeding due to ischaemic colitis?
Self limiting
63
What complications are associated with ischaemic colitis?
- Gangrene
| - Perforation
64
What is the appearance of ischaemic colitis?
Dusky blue swollen mucosa
65
What is there a history of in radiation proctitis?
Previous history of radiotherapy especially for cervical/prostate cancer
66
What be people with radiation proctitis be dependent on?
Blood transfusions due to chronic loss
67
What is the treatment for radiation proctitis?
- APC
- Sulcrafate enemas
- Hyperbaric oxygen
68
What is included in the umbrella term IBD?
- UC
| - CD
69
What does treatment of IBD depend on?
Extent/severity
70
If there is no colonic cause of lower GI bleeding and upper GI bleeding has been excluded what should be considered?
Small bowel origin
71
What small bowel origins of bleeding is there?
- Meckels diverticulum
- Small bowel angiodysplasia
- Small bowel tumour/GIST
- Small bowel ulceration (NSAID associated)
- Aortoentero fistula
72
What small bowel investigations are there for bleeding?
- CT angiogram
- Meckels scan (scintigraphy)
- Capsule endoscopy
- Double balloon enteroscopy
73
What is the diagnostic investigation for Meckel's diverticulum?
Nuclear scintigraphy
74
Meckel's diverticulum
Gastric reminant mucosa
75
What protocol should be followed for GI bleeding?
Major haemorrhage protocol
76
What approach should be used for resuscitation for GI bleeding?
ABCDE
77
How should circulation be dealt with immediately?
- Wide bored IV access
- Iv fluids
- Blood transfusion (if Hb <7g/dl or ongoing bleeding)
- Urgent bloods
78
Once resuscitated, what else is involved in the management of acute GI bleeding?
- Risk stratification for placement in HDU
- Endoscopy once stable
- Withhold/reverse contributory medications
- Specific medications
- Consider CT angiography/interventional radiology/surgical interventions as appropriate
79
Shock
Circulatory collapse resulting in inadequate tissue oxygen delivery leading to global hypo perfusion and tissue hypoxia
80
What are the signs of haemorrhagic shock?
- Tachypnoea
- Tachycardia
- Anxiety or confusion
- Cool clammy skin
- Ogliuria
- Hypotension
81
How can shock be classified?
4 stages according to total blood loss
82
What is the Blatchford score used for?
Decide who requires endoscopy
83
What does the Rockall score predict?
Principally used to predict death but can also be used to predict rebleed
84
What is the link with age and lower GI bleeding?
-Often in the elderly
85
What is the link between co-morbidities an lower GI bleeding?
Presence of 2 co-morbid conditions doubles the chances of severe bleed
86
What is the management for peptic ulcers?
- Proton pump inhibitor
- Endoscopy with endotherapy
- Angiography with embolization
- Laparotomy
87
What endoscopic therapy options are there for peptic ulcers?
- Injection
- Thermal
- Mechanical
- Haemospray
- Combination
88
If a peptic ulcer bleeds uncontrollably endoscopically what should be done?
- Angiography and embolization
| - Laparotomy
89
What options are there for endotherapy for varices?
Endotherapy
- Oesophageal (band ligation/ glue injection)
- Gastric (glue injection)
- Rectal (glue injection)
90
What should the patient ideally be when undergoing endotherapy for varices?
Intubated for airway protection
91
What is involved in the management of varices?
- Endotherapy
- IV terlipressin (vasoconstrictor of splanchnic blood supply)
- Iv broad spectrum antibiotics
- Correct coagulopathy
92
What options are there when bleeding is uncontrollable at endoscopy of varices?
- Sengstaken-Blakemore tube
| - Transjugular intrahepatic porto-systemic shunt
