gi bleeding

Question 1

what is haematemesis

Answer 1

vomiting of blood

Question 2

what is melaena

Answer 2

passage of black tarry stools

black is due to blood altered by passage through the gut

Question 3

what is passage of dark blood and clots without shock due to

Answer 3

lower GI bedding

Question 4

what is most common cause of serious and life threatening GI bleeding

Answer 4

peptic ulcer

Question 5

what can cause significant GI bleeding in developing world

Answer 5

viral infections

Question 6

what are causes of upper GI bleeding

Answer 6

• mallory-weiss syndrome
• gastric ulcer
• duodenal ulcer
• varices
• gastric varices
• gastric carcinoma

Question 7

what drugs can produce ulcers

Answer 7

• aspirin

- NSAIDs

Question 8

what scoring is based clinical and endoscopy findings

Answer 8

Rockall score

Question 9

what scoring is based on plasma urea, haemoglobin and clinical markers

Answer 9

Blatchford score

Question 10

what is immediate management

Answer 10

stop:

• NSAIDs
• aspirin
• clopidogrel
• warfarin

stopping anti-platelets can. be dangerous and may produce thrombosis

Question 11

what is done to diagnose

Answer 11

endoscopy

Question 12

how are varices treated

Answer 12

banding

Question 13

what else is used for bleeding varices

Answer 13

stenting

Question 14

treatment for bleeding ulcers

Answer 14

• injection with adrenaline
• endoscopic clipping
• inject thermal coagulation

select 2/3

Question 15

what should be done

Answer 15

antral biopsies to look for H.pylori

Question 16

what should be done first for treatment after endoscopy

Answer 16

IV PPI

because it reduces bleeding rates and need for surgery

Question 17

what is mallory-weiss tear

Answer 17

linear mucosal tear occurring in oesophagogastric junction

Question 18

what does mallory-weiss tear often follow

Answer 18

bought of coughing or retching

commonly seen after alcoholic ‘dry heaves’

Question 19

treatment for mallory-weiss tear if any

Answer 19

clipping

surgery with oversewing if tear is really bad but rarely

Question 20

treatment if patient has chronic peptic ulcer

Answer 20

eradication of H.pylori

Question 21

what is continued if patient has chronic peptic ulcer and for how long

Answer 21

PPI for 4 weeks to ensure ulcer healing

Question 22

what is done if bleeding is not under control in patient with peptic ulcer

Answer 22

angiography and embolisation
or
surgery

Question 23

what is massive bleeding from lower GI tract due to

Answer 23

diverticular disease
or
ischaemic colitis

Question 24

what are common cause of small bleeds

Answer 24

haemorrhoids

anal fissure

Question 25

other causes of lower GI bleeds

Answer 25

- angiodysplasia - carcinoma - diverticula - meckel's diverticulum - anal fissure - colitis - haemorrhoids - polyps - ischaemic colitis

Question 26

do lower GI bleeds usually stop spontaneously

Answer 26

yes

Question 27

how is diagnosis of lower GI bleed usually done

Answer 27

history and examination (rectal exam)

Question 28

what investigations are done for lower GI bleeds

Answer 28

- proctoscopy - flexible sigmoidoscopy - video capsule endoscopy - angiography

Question 29

what is proctoscopy good for

Answer 29

haemorrhoids

Question 30

what is sigmoidoscopy good for

Answer 30

IBD cancer ischaemic colitis diverticular disease

Question 31

what do patients with chronic GI bleeding have with it

Answer 31

anaemia

Question 32

what is primary concern of GI bleeding in adults

Answer 32

cancer of stomach, right colon and coeliac disease

Question 33

what is most common cause of chronic GI blood loss

Answer 33

hookworm uncommon in developed world

Question 34

what is usually performed first in chronic GI bleeding

Answer 34

upper GI endoscopy

Question 35

what should be done during endoscopy for chronic GI bleeding

Answer 35

biopsy to diagnose coeliac disease

Question 36

what is done second in chronic GI bleeding

Answer 36

colonoscopy

Question 37

what is useful diagnosis for colon cancer in frail patients

Answer 37

CT

Question 38

what is an alternative to colonoscopy

Answer 38

CT colonography

Question 39

what is diagnostic investigation of choice for upper GI bleeding

Answer 39

capsule endoscopy

Question 40

what is given to treat anaemia

Answer 40

oral iron