GI bleeding Flashcards
(87 cards)
1
Q
melaena =
A
passage of black tarry stools -distinctive smell
2
Q
where does the bleeding occur to form melaena
A
proximal to the right colon
3
Q
most common cause of GI bleeding
A
peptic ulcer
4
Q
2 locations of peptic ulcer
A
duodenal
gastric
5
Q
ulcer=
A
inflammation that can extend to whole length of gastric wall
6
Q
mucosa contains
A
- non-ciliated simple columnar
- basement membrane
- lamina propria
7
Q
symptoms of peptic ulcers
A
dyspepsia
epigastric pain
N&V
chest pain
8
Q
with a peptic ulcer when is epigastric pain worse
A
eating
9
Q
when is epigastric pain better
A
lying flat and antacids
10
Q
what type of bacteria is H.pylori
A
gram negative
11
Q
what does H.pylori do to stomach
A
causes inflammation disrupting mucosa production
12
Q
Zollinger-ellison syndrome=
A
tumours in pancreas which causes overproduction of gastric acid
13
Q
risk factors for peptic ulcer
A
smoking age family history blood group A NSAID use
14
Q
gastritis symptoms=
A
dyspepsia epigastric pain anorexia bloating N&V
15
Q
gastritis=
A
inflammation in stomach lining with no ulcer present
16
Q
most common cause of gastritis=
A
H.pylori infection
17
Q
mallory-weiss tear=
A
bleeding from a longitudinal laceration in mucosa and submucosa at junction between oesophagus and stomach
18
Q
presentation of mallory-weiss tear
A
haematemesis
abdominal pain
involuntary retching
melena
19
Q
chronic history of what for mallory-weiss tear
A
alcoholism and bulimia
20
Q
oesophagitis presentation =
A
dysphagia impaction of food heart burn N&V abdo pain
21
Q
what is oesophagitis highly associated with
A
hiatus hernias
22
Q
2 types of hernias
A
sliding hernias
rolling hernias
23
Q
sliding hernia=
A
gastro-oesophageal junction slides into chest
24
Q
rolling hernia=
A
bulge of the stomach herniates alongside oesophagus gastro-oesophageal junction remains still
25
in younger patients what is the most common type of oesophagitis
eosinophilic
26
what is eosinophilic oesophagitis
TH2 allergic response eosinophilic infiltration into the mucosa
27
gastro-oesophageal cancer presentation (6)
```
anorexia
weight loss
N&V
dysphagia
regurgitation
hoarseness and cough
```
28
2 forms of gastro-oesophageal cancer
squamous cell
| adenocarcinoma
29
oesophageal cancer more common in developing world -associated with poor diet upper 2/3
squamous cell
30
adenocarcinoma found in which part of oesophagus
lower 1/3
31
main association with adenocarcinoma of oesophagus
Barrett's oesophagus
32
what happens in Barretts oesophagus
squamous cell metaplasia into simple columnar with goblet cells
33
oesophageal varices=
extremely inflamed submucosal veins in lower third of oesophagus
34
presenting of oesophageal varices
haematemesis
melena
hematochezia
jaundice
35
why are veins dilated in oesophageal varices
congestion of blood from increased portal hypertension
36
causes of portal hypertension (3)
cirrhosis
hepatitis
alcoholism
37
features of liver disease (6)
```
jaundice
parotitis
spider naevi
palmar erythema
hepatosplenomegaly
ascites
```
38
3 consequences of portal HTN
encephalopathy
splenomegaly
peripheral oedema
39
treatment of oesophageal varices
ABCDE
| therapeutic endoscopy
40
therapeutic endoscopy for varices
variceal ligation
| banding or sclerotherapy
41
sclerotherapy=
adrenaline and thrombin
42
medications that can increase susceptibility to GI bleed (6)
```
warfarin
prednisolone
NSAIDs
SSRIs
calcium channel blockers
```
43
angiodysplasia=
small vascular malformation of gut
44
angiodysplasia most common in which area
caecum or ascending colon
45
development of angiodysplasia because
increased strain on the bowel wall due to chronic intermittent contraction of the colon
46
treatment of angiodysplasia
blood transfusion and endoscopic treatment
47
GAVE=
gastric antral vascular ectasia
48
endoscopy for GI bleeding
- endoscopy offered immediately to unstable patients after resus
- within 24 hrs for everyone else
49
blood tests for GI bleeds
FBC
platelets
biochemistry
LFTs
50
why can FBC be normal after a GI bleed
as haemodilution hasn't occurred yet
51
why might platelets be low in GI bleeding
hypersplenism due to portal hypertension
52
why do you get elevated urea relative to Cr in GI bleeds
high protein meal due to blood in GI tract
53
chronic liver disease effect on hepatic synthesis
low serum albumin
| + coagulopathy
54
acute assessment of GI bleed (4)
resuscitation
blatchford scale
history
endoscopy
55
chronic assessment of GI bleed
```
faecal occult blood
FBC
stool sample -H.pylori
ABGs and ECGs
flexible sigmoidoscopy or colonoscopy
```
56
2 scales assessing severity of bleed / likelihood of recurrence
blatchford and rockall scores
57
which scale requires an endoscopy
rockall
58
2 medications taken for 5 days after variceal upper GI bleed
terlipressin
| octerotide
59
terlipressin=
vasopressin analogue
60
octreotide=
somatostatin analogue
61
what do terlipressin and octreotide do
reduce portal hypertension and collateral pressure being applied to oesophageal veins
62
endoscopic treatment of varices (3)
- band ligation
- sclerotherapy
- injection of N-butyl-cyanoacrylate
63
therapy to eradicate H.pylori (3)
clarithromycin
amoxicillin
PPI
64
peptic ulcer management (4)
- endoscopy
- 72 hours PPI infusion +oral treatment after
- stop NSAIDs
- lifestyle education
65
when is interventional radiology used
when patients GI bleeds remain resistant to medical and endoscopic treatment
66
internal haemorrhoids present as
painless
| bright red bleeding when defecating
67
external haemorrhoids present as (3)
- pain and swelling in area of anus
- pruritus ani
- feeling inadequate cleaning
68
ischaemic colitis presentation (5)
```
abdo pain
hematochezia/ melena
diarrhoea
abdominal bruit
cardiovascular shock
```
69
what is ischaemic colitis
superior mesenteric arteries supplying colon are occluded due to thromboembolic events
70
what area of the colon is most affected in ischaemic colitis and why
splenic flexure -least collateral blood supply
71
diverticulosis presentation (5)
- LQ abdominal pain, guarding and tenderness
- fever
- rectal bleeding
- bloating
- constipation
72
strong history for diverticulosis=
over 50 with low fibre intake
73
what can obstruct the bowel in crohn's
strictures formed by muscular hypertrophy
74
cramping in Crohn's is most commonly in the
RLQ
75
anal fissures presentation
pain on defecation
hematochezia
anal spasm
76
what are anal fissures a common complication of
Crohn's
77
symptoms of right sided colon cancer (5)
- malaise
- weight loss
- vague abdominal pain
- palpable mass in right iliac
- iron deficiency anaemia
78
which colon cancer presents later
right sided
79
symptoms of left sided colon cancer
- obstructive symptoms
- colicky pain
- change in bowel habit
- passage of mucus
80
symptoms of rectal tumours
rectal bleeding
mucus discharge
tenesmus
81
which colon cancer is more likely to present with increased frequency and looser stools +rectal bleeding
left sided
82
1mL of blood loss needs
3mL of crystalloid fluid
83
OGD=
oesophago-gastro-duodenoscopy
84
3 ulcer grades
type 1, 2 and 3
85
type 3 ulcer=
clean based lesion with no stigmata of bleeding
86
type 1 ulcers=
spurting or oozing type 100% probability of re-bleed
87
type 1 ulcers=
recent bleed thrombosed
| 50% chance of re-bleed
