GI Haemorrhage

Question 1

Describe the symptoms of upper GI bleeding?

Answer 1

May have symptoms associated with anaemia:

• fatigue
• malaise
• breathlessness

Haematemesis
Melaena

May be asymptomatic and be an incidental finding of a microcytic anaemia.

Question 2

What are the commonest causes of haematemesis?

Answer 2

Oesophageal varices
Peptic ulcer
Mallory-weiss tear (trauma due to excessive vomiting, not serious)

Question 3

What are the causes of acute lower GI bleeding?

Answer 3

Refers to recent onset blood loss originating from the colon.

• Haemarrhoids
• Polyps or malignancy
• IBD
• Diverticuli

Question 4

Describe the initial management of a patient with a GI haemorrhage?

Answer 4

Resus (A-E)

A: Is the airway patent? Adjuncts needed)

B: Sats? O2 needed? Chest clear.

C: Perfused, BP, pulse? Massive haemorrhage protocol? Send bloods including X match. Heart sounds + ECG.

D: AVPU, BM.

E: Abdo, expose, PR.

If oesophageal varices give Telepressin.

Question 5

Describe the management of lower GI haemorrhage?

Answer 5

Resus

CT angiography/contrast or felxi-sigmoidoscopy/colonoscopy to identify cause an may be able to stop the bleed.

Intervention radiology can be used to embolise the bleed.

Catastrophic bleeds in the lower GI are very rare.