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Block 32- GI/surgery > GI bleeding > Flashcards

GI bleeding Flashcards

1
Q

melaena =

A

passage of black tarry stools -distinctive smell

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2
Q

where does the bleeding occur to form melaena

A

proximal to the right colon

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3
Q

most common cause of GI bleeding

A

peptic ulcer

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4
Q

2 locations of peptic ulcer

A

duodenal

gastric

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5
Q

ulcer=

A

inflammation that can extend to whole length of gastric wall

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6
Q

mucosa contains

A
  • non-ciliated simple columnar
  • basement membrane
  • lamina propria
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7
Q

symptoms of peptic ulcers

A

dyspepsia
epigastric pain
N&V
chest pain

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8
Q

with a peptic ulcer when is epigastric pain worse

A

eating

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9
Q

when is epigastric pain better

A

lying flat and antacids

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10
Q

what type of bacteria is H.pylori

A

gram negative

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11
Q

what does H.pylori do to stomach

A

causes inflammation disrupting mucosa production

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12
Q

Zollinger-ellison syndrome=

A

tumours in pancreas which causes overproduction of gastric acid

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13
Q

risk factors for peptic ulcer

A 
smoking 
age 
family history 
blood group A 
NSAID use
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14
Q

gastritis symptoms=

A 
dyspepsia 
epigastric pain 
anorexia 
bloating 
N&V
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15
Q

gastritis=

A

inflammation in stomach lining with no ulcer present

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16
Q

most common cause of gastritis=

A

H.pylori infection

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17
Q

mallory-weiss tear=

A

bleeding from a longitudinal laceration in mucosa and submucosa at junction between oesophagus and stomach

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18
Q

presentation of mallory-weiss tear

A

haematemesis
abdominal pain
involuntary retching
melena

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19
Q

chronic history of what for mallory-weiss tear

A

alcoholism and bulimia

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20
Q

oesophagitis presentation =

A 
dysphagia 
impaction of food
heart burn 
N&V 
abdo pain
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21
Q

what is oesophagitis highly associated with

A

hiatus hernias

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22
Q

2 types of hernias

A

sliding hernias

rolling hernias

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23
Q

sliding hernia=

A

gastro-oesophageal junction slides into chest

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24
Q

rolling hernia=

A

bulge of the stomach herniates alongside oesophagus gastro-oesophageal junction remains still

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25
Q

in younger patients what is the most common type of oesophagitis

A

eosinophilic

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26
Q

what is eosinophilic oesophagitis

A

TH2 allergic response eosinophilic infiltration into the mucosa

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27
Q

gastro-oesophageal cancer presentation (6)

A 
anorexia 
weight loss
N&V
dysphagia 
regurgitation 
hoarseness and cough
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28
Q

2 forms of gastro-oesophageal cancer

A

squamous cell

adenocarcinoma

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29
Q

oesophageal cancer more common in developing world -associated with poor diet upper 2/3

A

squamous cell

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30
Q

adenocarcinoma found in which part of oesophagus

A

lower 1/3

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31
Q

main association with adenocarcinoma of oesophagus

A

Barrett’s oesophagus

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32
Q

what happens in Barretts oesophagus

A

squamous cell metaplasia into simple columnar with goblet cells

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33
Q

oesophageal varices=

A

extremely inflamed submucosal veins in lower third of oesophagus

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34
Q

presenting of oesophageal varices

A

haematemesis
melena
hematochezia
jaundice

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35
Q

why are veins dilated in oesophageal varices

A

congestion of blood from increased portal hypertension

36
Q

causes of portal hypertension (3)

A

cirrhosis
hepatitis
alcoholism

37
Q

features of liver disease (6)

A 
jaundice 
parotitis 
spider naevi
palmar erythema 
hepatosplenomegaly 
ascites
38
Q

3 consequences of portal HTN

A

encephalopathy
splenomegaly
peripheral oedema

39
Q

treatment of oesophageal varices

A

ABCDE

therapeutic endoscopy

40
Q

therapeutic endoscopy for varices

A

variceal ligation

banding or sclerotherapy

41
Q

sclerotherapy=

A

adrenaline and thrombin

42
Q

medications that can increase susceptibility to GI bleed (6)

A 
warfarin 
prednisolone 
NSAIDs 
SSRIs 
calcium channel blockers
43
Q

angiodysplasia=

A

small vascular malformation of gut

44
Q

angiodysplasia most common in which area

A

caecum or ascending colon

45
Q

development of angiodysplasia because

A

increased strain on the bowel wall due to chronic intermittent contraction of the colon

46
Q

treatment of angiodysplasia

A

blood transfusion and endoscopic treatment

47
Q

GAVE=

A

gastric antral vascular ectasia

48
Q

endoscopy for GI bleeding

A
  • endoscopy offered immediately to unstable patients after resus
  • within 24 hrs for everyone else
49
Q

blood tests for GI bleeds

A

FBC
platelets
biochemistry
LFTs

50
Q

why can FBC be normal after a GI bleed

A

as haemodilution hasn’t occurred yet

51
Q

why might platelets be low in GI bleeding

A

hypersplenism due to portal hypertension

52
Q

why do you get elevated urea relative to Cr in GI bleeds

A

high protein meal due to blood in GI tract

53
Q

chronic liver disease effect on hepatic synthesis

A

low serum albumin

+ coagulopathy

54
Q

acute assessment of GI bleed (4)

A

resuscitation
blatchford scale
history
endoscopy

55
Q

chronic assessment of GI bleed

A 
faecal occult blood 
FBC 
stool sample -H.pylori 
ABGs and ECGs
flexible sigmoidoscopy or colonoscopy
56
Q

2 scales assessing severity of bleed / likelihood of recurrence

A

blatchford and rockall scores

57
Q

which scale requires an endoscopy

A

rockall

58
Q

2 medications taken for 5 days after variceal upper GI bleed

A

terlipressin

octerotide

59
Q

terlipressin=

A

vasopressin analogue

60
Q

octreotide=

A

somatostatin analogue

61
Q

what do terlipressin and octreotide do

A

reduce portal hypertension and collateral pressure being applied to oesophageal veins

62
Q

endoscopic treatment of varices (3)

A
  • band ligation
  • sclerotherapy
  • injection of N-butyl-cyanoacrylate
63
Q

therapy to eradicate H.pylori (3)

A

clarithromycin
amoxicillin
PPI

64
Q

peptic ulcer management (4)

A
  • endoscopy
  • 72 hours PPI infusion +oral treatment after
  • stop NSAIDs
  • lifestyle education
65
Q

when is interventional radiology used

A

when patients GI bleeds remain resistant to medical and endoscopic treatment

66
Q

internal haemorrhoids present as

A

painless

bright red bleeding when defecating

67
Q

external haemorrhoids present as (3)

A
  • pain and swelling in area of anus
  • pruritus ani
  • feeling inadequate cleaning
68
Q

ischaemic colitis presentation (5)

A 
abdo pain 
hematochezia/ melena 
diarrhoea 
abdominal bruit 
cardiovascular shock
69
Q

what is ischaemic colitis

A

superior mesenteric arteries supplying colon are occluded due to thromboembolic events

70
Q

what area of the colon is most affected in ischaemic colitis and why

A

splenic flexure -least collateral blood supply

71
Q

diverticulosis presentation (5)

A
  • LQ abdominal pain, guarding and tenderness
  • fever
  • rectal bleeding
  • bloating
  • constipation
72
Q

strong history for diverticulosis=

A

over 50 with low fibre intake

73
Q

what can obstruct the bowel in crohn’s

A

strictures formed by muscular hypertrophy

74
Q

cramping in Crohn’s is most commonly in the

A

RLQ

75
Q

anal fissures presentation

A

pain on defecation
hematochezia
anal spasm

76
Q

what are anal fissures a common complication of

A

Crohn’s

77
Q

symptoms of right sided colon cancer (5)

A
  • malaise
  • weight loss
  • vague abdominal pain
  • palpable mass in right iliac
  • iron deficiency anaemia
78
Q

which colon cancer presents later

A

right sided

79
Q

symptoms of left sided colon cancer

A
  • obstructive symptoms
  • colicky pain
  • change in bowel habit
  • passage of mucus
80
Q

symptoms of rectal tumours

A

rectal bleeding
mucus discharge
tenesmus

81
Q

which colon cancer is more likely to present with increased frequency and looser stools +rectal bleeding

A

left sided

82
Q

1mL of blood loss needs

A

3mL of crystalloid fluid

83
Q

OGD=

A

oesophago-gastro-duodenoscopy

84
Q

3 ulcer grades

A

type 1, 2 and 3

85
Q

type 3 ulcer=

A

clean based lesion with no stigmata of bleeding

86
Q

type 1 ulcers=

A

spurting or oozing type 100% probability of re-bleed

87
Q

type 1 ulcers=

A

recent bleed thrombosed

50% chance of re-bleed

Block 32- GI/surgery (9 decks)

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