Acute GI Bleeding

Question 1

define upper GI bleeding

Answer 1

bleeding from oesophagus, stomach or duodenum

Question 2

lower GI bleeding

Answer 2

bleeding distal to duodenum

Question 3

upper GI bleeding signs/ symptoms

Answer 3

• haematemesis
• malaena (partly digested blood)
• elevated urea (digested blood becomes urea)
• dyspepsia
• reflux
• epigastric pain

Question 4

maleana

Answer 4

digested blood (has a dark/ black appearance in stool)

Question 5

lower GI bleeding signs/ symptoms

Answer 5

• fresh blood/ clots
• magenta stools
• normal urea
• typically painless
• commonly presents at an advanced age

Question 6

causes of upper GI bleeding oesophagus

Answer 6

ulcers

varices

mallory weiss tear

malignancy

Question 7

causes of stomach bleeding

Answer 7

gastric varicose

portal hypertensive gastropathy

malignancy

dieulafoy

angiodysplasia

Question 8

causes of duodenal bleeding

Answer 8

anhiodysplasia

Question 9

gold standard investigation of upper GI bleeding

Answer 9

endoscopy <24hours

Question 10

causes of acute lower GI Bleeding

Answer 10

diverticular disease

haemorrhoids

vascular malformation

neoplasia

ischaemic colitis

IBD

radiation enteropathy/proctitis

Question 11

What is required for the diagnosis of acute lower GI bleeding

Answer 11

flexible sigmoidoscopy

full colonoscopy

Question 12

acute lower GI bleeding investigations

Answer 12

lower GI endoscopy:

• flexible sigmoidoscopy
• colonoscopy

CT angiography

Question 13

acute lower GI bleeding - small bowel causes??

Answer 13

• Meckels diverticulum
• small bowel angiodysplasia
• small bowel tumour
• small bowel ulceration
• aortoentero fistulation (following AAA repair)

Question 14

acute lower GI bleeding small bowl investigations

Answer 14

CT angiogram

Meckels scan

capsule endoscopy

double balloon enteroscopy

Question 15

Management of GI bleeding - circulatory system

Answer 15

• wide bored IV access for IV fluids and blood transfusion
• urgent blood samples
• blood transfusion
• catheter

Question 16

Blatchfords Score - pre-endoscopy score

Answer 16

• blood urea
• haemoglobin
• systolic blood pressure
• other markers (e.g. hepatic disease, cardiac failure)

Question 17

low-risk criteria of Glasgow Blatchford Score (factors that mean you are at low risk)

Answer 17

urea <6·5 mmol/L
haemoglobin >=130 g/L (men) or >=120 g/L (women)
systolic blood pressure >=110 mm Hg
pulse <100 beats per min
absence of melaena, syncope, cardiac failure, or liver disease

Question 18

what age does acute lower GI bleeding occur?

Answer 18

mostly elderly

Question 19

what percentage of inpatients with a rectal bleed die

Answer 19

23%

Question 20

what drugs put you at an increased risk of lower GI bleeding

Answer 20

NSAIDs

Aspirin