Upper GI bleed, Diarrhoea, Constipation

Question 1

What are common causes of upper GI bleeding?

Answer 1

Peptic ulcers, Mallory-Weiss tear, Oesophageal varices, Gastritis/gastric erosions/Drugs/Oesophagitis/Duodenitis/Malignancy

Question 2

What are acute management steps to take in the case of upper GI bleed?

Answer 2

1. Protect the airway + High flow oxygen
2. Insert 2 large bore cannulae (FBC, U&E, LFT, cross-match, clotting)
3. IV fluids to restore intravascular volume - avoid saline if cirrhotic/varices. If still haemodynamically unstable, give O Rh -ve blood.
4. Urinary catheter
5. CXR, ECG, ABG
6. If suspicious of varices, give IV terlipressin + initiate broad spec Abx for cover

Question 3

How is risk scored for upper GI bleeds?

Answer 3

Rockall scoring system - pre-endoscopy and post-endoscopy.
Pre-endoscopy takes into account age, shock (SBP + pulse), comorbidities.
Post-endoscopy takes into account diagnosis and signs of recent haemorrhage on endoscopy.

Question 4

What is the Glasgow Blatchford score used for?

Answer 4

Used pre-endoscopy to identify patients at low risk of requiring intervention.

Question 5

How is risk stratified based on endoscopy findings in the case of peptic ulcer bleeds?

Answer 5

High risk: active bleeding, adherent clot or non-bleeding visible vessel.
Low risk: flat, pigmented spot or clean base.

Question 6

What are gastro-oesophageal varices and when do they bleed?

Answer 6

Submucosal venous dilatation secondary to portal hypertension. Bleeding occurs briskly especially if there is an underlying coagulopathy secondary to loss of hepatic synthesis of clotting factors.

Question 7

What are causes of portal hypertension?

Answer 7

Pre-heaptic: Thrombosis

Hepatic: Cirrhosis, Schistosomiasis, Sarcoidosis, Myeloproliferative disorders, Congenital hepatic fibrosis

Post-hepatic: Budd-Chiari, Right heart failure, Constrictive pericarditis, Veno-occlusive disease

Question 8

What are causes of bloody diarrhoea?

Answer 8

Campylobacter, Shigella/Salmonella, E.Coli, amoebiasis, UC, Crohn’s, colorectal cancer, colonic polyps, pseudomembranous colitis, ischaemic colitis, fresh PR bleed

Question 9

What are causes of mucus in stool?

Answer 9

IBS, colorectal cancer and polyps

Question 10

What are causes of pus in stool?

Answer 10

IBD, diverticulitis or fistula/abscess

Question 11

What are causes of explosive diarrhoea?

Answer 11

Cholera, Giardia, Yersinia, Rotavirus

Question 12

What are causes of steatorrhoea?

Answer 12

Pancreatic insufficiency, biliary obstruction

Question 13

What are predictors of fulminant C.diff colitis?

Answer 13

Age over 70, past C.diff infection, use of anti-peristaltic drugs, severe leucocytosis, haemodynamic instability

Question 14

What are classic features of pancreatitis?

Answer 14

epigastric abdominal pain radiating to the back, steatorrhoea, malnutrition, and diabetes mellitus.

Question 15

What are causes of pancreatitis?

Answer 15

Alcohol, smoking, autoimmune
Rare: CF, haemochromatosis, pancreatic duct obstruction, congenital (pancreas divisum)

Question 16

What imaging is done for pancreatitis?

Answer 16

CT or MRI

Will show pancreatic calcifications, focal or diffuse enlargement of the pancreas, ductal dilation, and/or vascular complications

Question 17

How is chronic pancreatitis managed?

Answer 17

Analgesia, lipase, fat-soluble vitamins. Pancreatectomy/pancreaticojejunostomy may be required.