GI Haemorrhage Flashcards
Symptoms, signs and causes of upper GI bleed
Main symptoms: Haematemesis and melaena, unaltered blood in stool due to haemorrhage/shock. Severe intravascular volume depletion: causes postural hypotension. Tachycardic, signs of chronic liver disease.
All patients with a significant GI Bleed should be seen.
Causes:
1) Chronic peptic ulcer (50%)- if bleeding not controlled, surgical ligation. Treatment: Adrenaline injection, thermal coagulation and PPI.
2) Haemorrhagic erosion and gastropathy causes rebleed. (15-20%).
3) Oesophageal varices should be banded.
4) Mallory-Weiss tear due to increase in IAP.
Lower GI Bleed symptoms and causes?
Massive bleeds: Diverticular Disease and Ischaemic Colitis. Anal fissures and haemorrhoids cause small bleeds. Most acute bleeds start and stop spontaneously. Treat persistent bleeds as upper bleeds: stop blood thinners, consider fluids, watch Hb (<10). Causes of bleeds: Carcinoma, Diverticula, Angiodysplasia, Ischaemic Colitis, Crohn’s ulcers, fistulae, haemorrhoids and fissures.
Presentation of lower GI bleed
Presents as anaemia. Post-menopausal chronic blood loss. Perform colonoscopy and remove lesions. Treat with oral iron supplement.
