Acute GI Bleeding

Question 1

What is haematemsis?

Answer 1

Vomiting blood

Question 2

What is melaena?

Answer 2

Jelly like black tarry stools

Question 3

Where is the bleed suggested in haemetemesis?

Answer 3

Upper GI

Question 4

Where is the bleed suggested melaena?

Answer 4

Upper GI

Blood has been digested as passing through the gut

Question 5

What are some oesophageal causes of upper GI bleeding?

Answer 5

Oesophageal varices
Oesophageal malignancy
Ulcers
Mallory Weiss Tar

Question 6

What are some gastric causes of upper GI bleeding?

Answer 6

Gastric varices (due to portal hypertension)
Gastric malignancies
Dieulafoy
Submucosal arteriolar vessel eroding through the mucosa
Gastric funduse
ULCERS

Question 7

What are duodenal causes of upper GI bleeding?

Answer 7

Angiodysplasia
Vascular malformation
Ulcers

Question 8

What is the most common cause of upper GI bleeding?

Answer 8

Ulcers

Question 9

What are more common duodenal or gastric ulcers?

Answer 9

Duodenal

Question 10

What is mallory weiss tear?

Answer 10

Tear where the oesophagus meets the stomach

Question 11

What are risk factors for peptic ulcers?

Answer 11

H.pylori infection
NSAIDS
Alcohol excess
Systemic illness

Question 12

What is the link between gastric ulcers and gastric carcinoma?

Answer 12

Gastric ulcers can sit over gastric carcinomas

Question 13

What are oesophageal varices second to?

Answer 13

Secondary to portal hypertension

Question 14

What is portal hypertension usually due to?

Answer 14

Liver cirrhosis

Question 15

Why are oesophageal varices so serious?

Answer 15

Can rupturing can cause severe haemorrhage

Question 16

What are the 2 main symptoms of oesophageal cancer?

Answer 16

Dysphagia

Weight loss history

Question 17

What are the key HPC questions for the abdomen?

Answer 17

Dyspepsia?
Weight loss 
Collapse 
Poor urine 
Melaena 
Haematemesis

Question 18

What are the key PMH questions for the abdomen?

Answer 18

History of liver disease?

Question 19

What are the key D&A questions for the abdomen?

Answer 19

NSAIDS
Steroids
Anti-coagulants
Anti-platelets

Question 20

What are the key SH questions for the abdomen?

Answer 20

Alcohol

Smoking history

Question 21

Where is lower GI bleeding classed from?

Answer 21

Bleeding distal to duodenum

Question 22

What is the typical presentation of a lower GI bleed?

Answer 22

Fresh blood in stools

Question 23

What are some potential causes for lower GI bleeding?

Answer 23

Diverticular disease
Haemorrhoids 
Vascular malformations 
Neoplasia 
Ischamia colitis 
Radiation enteropathy 
IBS

Question 24

What does diagnosis for lower GI bleeding require?

Answer 24

Flexible sigmoidoscopy

or full colonoscopy

Question 25

What is diverticular disease?

Answer 25

When there is protrusion of the inner mucosal lining through the outer muscular layer

Question 26

What is diverticulits

Answer 26

Inflammation in diverticular disease

Question 27

What % of diverticulitis is self limiting?

Answer 27

75%

Question 28

Who are haemorrhoids more common in?

Answer 28

Younger people

Question 29

What are haemorrhoids?

Answer 29

Enlarged vascular cushions around the anal canal

Question 30

What causes ischeamic colitis?

Answer 30

Disruption to the blood supply of the colon

Question 31

Which part of the bowel is affected in ischaemic bowel disease?

Answer 31

Depends on if the SMA or IMA is affected

Question 32

What is the appearance of the bowel on colonoscopy in ischamic colitis?

Answer 32

Bruise like appearance | Dusky blue

Question 33

What are the 2 categories of IBD?

Answer 33

Ulcerative Colitis | Crohn's Disease

Question 34

What appearance does IBD give on colonoscopy?

Answer 34

Cobblestone appearance

Question 35

What are some small bowel causes for GI bleeding?

Answer 35

Meckel's diverticulum Small bowel angiodysplasia Small bowel tumour Small bowel ulceration

Question 36

What is the first step to managing a GI bleed?

Answer 36

ABCDE approach

Question 37

What does A, B, C, D and E stand for?

Answer 37

``` Airway Breathing Circulation Disability Exposure ```

Question 38

When should an endoscopy be performed on a patient experiencing a GI bleed?

Answer 38

Once ABCDE has been covered and the patient is stable

Question 39

What is shock?

Answer 39

Circulatory collapse resulting in inadequate tissue oxygen delivery leading to global hypoperfusion and tissue hypoxia

Question 40

In which age group does acute lower GI bleeding more commonly occur?

Answer 40

In the elderly

Question 41

How many co-morbidities need to be present to double a patients chance of a severe GI bleed?

Answer 41

2

Question 42

Which drugs increase the risk of a lower GI bleed?

Answer 42

NSAIDS | Aspirin

Question 43

Which investigations are appropriate for those experiencing acute abdominal pain?

Answer 43

``` Xray Erect chest and abdominal xray Abdominal US CT scanning Contrast studies ```