GI: Upper GI bleeds, haematemesis and malaena Flashcards Preview

Year 3 Medicine Block > GI: Upper GI bleeds, haematemesis and malaena > Flashcards

Flashcards in GI: Upper GI bleeds, haematemesis and malaena Deck (16)
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1
Q
A
2
Q

What are the causes of an upper GI bleed?

A

Oesophageal varices
Mallory-Weiss tear
Peptic ulcers
Cancers of stomach or duodenum

3
Q

A patient presents with a GI bleed, what do you need to ascertain from their PMH?

A

Hx of varices or chronic liver disease
Any stigmata of (chronic) liver disease
use of :NSAIDs,Anti-platelets,Anti-coagulants

4
Q

What are the 2 scoring systems used in GI bleeding and what do they score?

A

Rockall- for patients that have or are going to have endoscopy, their risk of dying

Blatchford- establishes the risk of patient who you ?GI bleed is a GI bleed, used to determine whether should intervene

5
Q

What parameters does the Blatchford score take into account?

A

Drop in Hb
Rise in Urea
Blood pressure
Heart rate
Malaena
Syncope

6
Q

What do you need to establish if a patient has a GI bleed?

A

Is it variceal?

7
Q

What is the initial management for patients with GI bleeding

A

Used mneumonic ABATED
A- A-E assessment
B- Bloods
A-Access- IV access - if pt haemodynamically compromised, resus fluids and then transfuse
T- Transfuse
E- Endoscopy
D- Drugs, stop any NSAIDs or Anticoagulants

8
Q

What bloods do you need to do for a patient with GI bleeding and WHY?

A

FBC and Platelets- Check if Hb is dropping and thrombocytopenia can indicate chronic liver disease. Platelets need to be replaced if lost

U&Es- rising urea supports diagnosis of GI bleed

LFTs- check liver function, may show impaired function/liver disease

VBG- quick Hb reading

Coag screening - are they bleeding due to a clotting disorder?

Crossmatch/group and save- crossmatch if patient is haemodynamically unstable

9
Q

You have started initial management for a patient with GI bleeding, the cause of this is suspected ruptured varices, what additional steps would you add in your management?

A

IV terlipressin
IV broad spec antibiotics

Endoscopic banding to stop the bleeding
If this fails- Linton tube or TIPSS (trans jugular intrahepatic porto systemic shunt)

10
Q

What is the most common cause of non-variceal GI bleeding?

A

Peptic ulcer disease

11
Q

What is dieulafoys?

A

An abnormally large artery in the lining of GI tract, most commonly the stomach

12
Q

How would a patient present with peptic ulcer disease?

A

Epigastric pain
Dyspepsia
Nausea and vomitting
Bleeding- malaena, coffee ground vomit or haematemesis
Iron deficiency anaemia

If duodenal ulcer (more common) = have epigastric pain when hungry, relieved by eating.
If gastric ulcer = epigastric pain worsened by eating

13
Q

How would you treat a patient that presents with peptic ulcer disease?

A

If actively bleeding see ABATED mnemonic in Z2F

Rapid urease test to check for H.pylori- treat with amoxicillin and clarithromycin for 7 days +PPI
PPIs is the mainstay of treatment

14
Q

What the complications of peptic ulcer disease?

A

Bleeding
Perforation leading to acute abdomen and/or peritonitis
Scarring/ strictures leading to pyloric stenosis

15
Q

What are some risk factors for variceal haemorrhage?

A

High portal pressures (>12mmHg)
Large varices
Abnormal variceal wall at endoscopy (eg haematocystic spots)
High Child-Pugh score

16
Q

How do you differentiate between an upper GI bleed vs lower GI bleed based on blood results?

A

Upper GI bleed more likely to have high urea

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