GI Bleeding Flashcards
(24 cards)
What are the four main clinical presentations of GI bleeding?
- Acute Upper GI Bleeding (UGIB) in adults
- Acute Lower GI Bleeding (LGIB) in adults
- Chronic GI Bleeding in adults
- Obscure or occult GI bleeding
What are the key components of assessing GI bleeding?
History, physical examination, risk assessment, and investigation.
What are signs of unstable UGIB?
Haemorrhagic shock, abnormal ABCDE, requires simultaneous triage and resuscitation.
What is melaena and what causes its black tarry appearance?
Blood in stool caused by >50ml of blood in the upper GI tract; pepsin action gives it a tarry, sticky appearance.
What are common causes of UGIB?
Peptic ulcer disease, oesophageal ulcers, Mallory-Weiss tear, variceal hemorrhage, malignancy.
What past medical history increases risk of UGIB?
CLD (chronic liver disease), previous GI bleeds (60% same lesson), AAA (aorto-enteric fistula), prior GI surgery.
What medications are risk factors for UGIB?
NSAIDs, aspirin, COX-2 inhibitors, anticoagulants, antiplatelets, iron supplements, bismuth.
What are key vital signs in UGIB assessment?
Increased RR/HR, decreased postural BP, decreased systolic BP.
What is part of the systematic GI examination in UGIB?
Assess for signs of CLD, anemia, jaundice, lymphadenopathy, perform DRE.
What percentage of LGIBs stop spontaneously?
80–90%
What are typical presentations of LGIB from the left colon/rectum?
Fresh, bright red blood not mixed with stool; possibly with clots.
What are symptoms of LGIB from the right colon?
Dark red or maroon blood, possibly mixed with stool or melaena.
What are common causes of LGIB?
Diverticular disease, haemorrhoids, ischaemia, IBD, colorectal cancer.
What is the significance of painless, large-volume PR bleeding?
Suggestive of diverticular bleeding or angiodysplasia.
What blood tests are commonly ordered for GI bleeding?
FBC, U+E, clotting studies, LFTs, crossmatch, +/- haematinics and iron studies, ABG + lactate.
Why might urea be elevated in UGIB?
Digestion of blood increases urea → elevated U:Cr ratio.
What are common causes of chronic GI bleeding?
PR bleeding, intermittent UGIB, iron deficiency anemia.
What are diagnostic criteria for iron deficiency anemia (IDA)?
Serum ferritin <30 ng/mL (or <15), transferrin saturation ≤19%, low MCV, anemia resolves with iron.
What is the fast track (2WW) referral pathway for IDA?
Colonoscopy + biopsy, gastroscopy + biopsy, coeliac screening.
What defines obscure GI bleeding?
Bleeding with no identified source after upper and lower GI endoscopy.
What percentage of obscure GI bleeds originate from the small bowel?
75%
What is the Shock Index, and what value indicates instability?
Shock Index = HR/SBP. A value >1 indicates instability.
What is the purpose of the Oakland Score in LGIB?
To predict need for transfusion, intervention, or mortality risk in LGIB.
What are key elements of the Oakland Score?
Age, DRE result, HR, Hb level.
