Gastrointestinal blood loss Flashcards
(22 cards)
What is the most common site of GI bleeding?
Upper GI tract (oesophagus, stomach and duodenum) – 70% of the time
- 30% is large bowel GI bleeding
- <1% is small bowel GI bleeding
What is the most likely cause of upper GI bleeding?
Peptic ulcer
Most common cause of large bowel bleeding?
Angiodysplasia
Diverticular disease
How will a patient present with an acute bleed?
- Haematemesis
- Malaena
- Shock
- Pr bleed
How will a patient with chronic bleeding present?
- Anaemia
- Fatigue
- SOB or chest pain
- incidental - Positive FOB (fecal occult blood)
Which examination would you do for chronic bleeding?
Abdominal
Which tests would you do for chronic bleeding investigation?
FBC U&E Haematinics Coeliac screen Endoscopy/colonoscopy/CT colonography Capsule/CT or MR enterography
What are the main steps of resuscitation? (ABC)
- Airway - aspirate blood from pharyx
- Blood - Take blood for X-match and other bloods
- Circulation - IV access - IV fluids
Which factors predict those with a significantly high risk of dying from an upper GI bleed?
- Age >65 yrs
- IHD, COAD, cirrhosis
- Chronic lung disease
- Shock on admission (pulse >100bpm, bp<100 or postural drop)
- Ascites
- Continued bleed
- Re-bleeding
- Hb <8g on admission
What are the score systems for GI bleeding?
- Rockall
2. Blatchford
What is the advantage of using the Blatchford scoring system over the Rockall?
Blatchford does not require an endoscopy
What does the Rockall scoring system take into account?
- Age
- Pulse
- Blood pressure
- Comorbidity
- Endoscopic diagnosis and stigmata
What does the Blatchford scoring system take into account?
- Urea
- Hb
- BP
- Pulse
- Presentation: melaena or syncope
- Cardiac or liver diseases
What is the first line treatment for an upper GI bleed?
Therapeutic endoscopy
- Aspirate blood from stomach
- Endoscopic intervention to look for ulcers, active bleeding and varices all of which would require endoscopic intervention
What does endoscopic therapy consist of? (for bleeding ulcers)
- Injection
- Adrenaline
- Sclerosants
- Thrombin/fibrin glue - Electrocoagulation
- Clips
- APC (argon plasma coagulation) - particularly used for angiodysplasia
How do you treat bleeding varices?
Endoscopic therapy
- Suck it up and place an elastic band around it (banding)
What are the first-line investigations for an acute lower GI bleed?
- Normal upper GI endoscopy (just to make sure the upper GI tract is fine)
- Colonoscopy
- Endoscopic therapy can be applied during procedure
- Determine the cause of bleeding
- Determine prognosis - Angiography
- CT or MR angiography with contrast (most easy) - allows determination of where the blood loss within the bowel is coming from
- Femoral angiography
- Angiographic intervention
How do you treat angiodysplasia during a colonoscopy via endoscopic therapy?
Injection and thermal methods
How do you treat polyps during a colonoscopy via endoscopic therapy?
Diathermy and excision
Management of acute bleeding
- Resuscitate (ABC)
- Clinical assessment - high risk or low risk
- Initial investigations: RBC, clotting studies, X-match, EUGs, ECG
- Endoscopy
- Medical therapy
- Surgery when indicated
Management of chronic bleeding
- History
- Clinical examination
- Abdominal examination
- PR
- Rigid sigmoidoscopy
- Blood test including RBC, U&E, haematinics
- Endoscopy, colonoscopy, CT colonography
- Capsule, CT, or MR small bowel
Management of varices
- Monitor on ITU
- central line
- urine output
- regular FBC, clotting, creatinine, electrolytes, blood gasses - Replace clotting factors: FFP, platelets etc
- Vasopressin, glypressin
- Somatostatin, octreotide
- Endoscopy: sclerotherapy or banding
