Management of Acute Upper GI Haemorrhage Flashcards Preview

Gastro > Management of Acute Upper GI Haemorrhage > Flashcards

Flashcards in Management of Acute Upper GI Haemorrhage Deck (35):
1

What is haematemesis?

Blood in the vomit - upper GI bleeding

2

What is melaena

Blood in the stool - A sign of Upper GI bleeding

3

What is GI bleeding?

A serious medical emergency until proven otherwise

4

What are the majority of GI bleeds

Self limiting with no in-hospital rebleed

5

What is the mortality rate for patients with continued or recurrent bleeding?

30-40%

6

What can cause upper GI bleeding

duodenal ulcer
gastric erosions
gastric ulcer
varices
Mallory -Weiss tear (repeated vomiting and then the appearance of blood)
Oeophagitis
Erosive duodenitis
neoplasm
stomal ulcer
oesophageal ulcer

7

How can you control the blood pressure of a patient?

IV access to give fluids

8

What venflon should be used with GI bleeding?

Grey venflon

9

What is the 100 rule?

systolic BP 100bpm
Hb 60
Comorbid disease
Postural drop in blood pressure

10

How many litres of circulating volume do you have?

5

11

How much can you afford to lose at a young age?

4

12

How much volume can you afford to lose at an older age?

1

13

What do you do if there is a high suspicion of GI bleed and what does this tell you?

Endoscopy
to identify the cause
to manage the cause
assess the risk of rebleed

14

What scoring system is used for to measure the risk of a upper GI rebleed ?
What is it scored on?

Rockall RIsk Scoring system
age
pulse
SBP
Presence or absence of co-morbidity

15

What does the Blatchford Scoring system determine?
Why is this advantageous of the Rockall RIsk Scoring System

The high risk of GI bleeding patients
It does not require an endoscopy

16

What do we do for patients that score 0-1 on the Blatchford Scoring system?

Require an outpatient endoscopy

17

What are the 3 high risk stigmatas of recent haemorrhage

Active bleeding/ oozing
Overlying clot
Visible vessel

18

How can you achieve haemostasis

Get a balance of thrombosis and thrombolysis

19

What are the endoscopic treatments of peptic ulcers?

Injection (best is 1/10000 adrenaline - gives a tamponade effect and a pharmacological effect of vasoconstriction)
Heater probe coagulation
Combinations
Clips - apply to achieve haemostasis
Haemospray - new device used as rescue therapy when the rest has not worked

20

What is the combination therapy?

Injection and heater probe coagulation

21

What is acute variceal bleeding

Varices are dilated submucosal veins, most commonly detected in the distal esophagus or proximal stomach

22

What causes variceal bleeding?

Cirrhotics
Complications such as sepsis and liver failure

23

What does intervention do in acute variceal bleeding?

Reduced bleeding related mortality

24

What happens as the resistance in the portal vein increases

The pressure increases and so the flow changes to try and find an alternative route back into the systemic system

25

When do you suspect varices in a bleeder?

Known history of cirrhosis with varices
History of chronic alcohol excess
Chronic viral hepatitis infection
metabolic or autoimmnue liver disease - intra-abdominal spesis/ surgery

26

What causes leukonychia?

Chronically low protein levels

27

What can portal hypertension cause

Spider naevi
Ascites
Encepalopothy
Leukonychia

28

What are the aims of management of variceal bleeding?

Resuscitation
Haemostasis
Prevent complication of bleeding
Prevent deteriorating liver failrure
Prevent rebleed

29

How do we achieve coagulopathy

Plasma donor and give Vitamin K

30

Why do we always give antibiotics to patients with variceal bleeding

people with cirrhosis - overall improves their mortality

31

How do we achieve haemostasis is varices?

Terlipressin (vasopressin analogue)
Endoscopic variceal ligation (banding)
Sclerotherapy - now not used as much due to high complications.
Sengestaken-Blakemore balloon - emergency situations
TIPS - in radiology - stent in the liver to reduce pressure in portal vein

32

What is Sengstaken- Blakemore Tube

it is a balloon into the stomach that is pulled back against the gastro-oesophageal junction causing increased pressure and it will tamponade

33

TIPS

Transjugular intrahepatic portosystemic shunt (TIPS). This is a procedure to create new connections between two blood vessels in your liver. This can decrease pressure in the veins and prevent bleeding episodes from happening again.

34

Why is propranolol used in variceal bleeds?

To reduce the pressure in the portal system

35

What happens if the hepatic function remains poor even after TIPS

Consider a transplant

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