GI Bleeding

Question 1

What are the clinical features of an upper GI Bleed?

Answer 1

• Hematemesis,
• Malaena,
• Coffee ground vomit
• Tachycardia
• Hypotension

Question 2

What are some causes of upper GI Bleeds?

Answer 2

• Oesophageal/gastric varices,
• Peptic ulcer disease,
• Gastritis/oesophagitis/duodenitis
• Malignancy,
• Angiodysplasia,
• Mallory Weiss tear

Question 3

Explain the management of upper GI bleeds

Answer 3

• ABATED - A-E assessment, Bloods, Access, Transfuse, Endoscopy and Drugs (stop anticoagulants and NSAIDs)
• Resuscitation with fluids, or blood transfusion if Hb <7.
• In suspected variceal bleeding terlipressin and antibiotics.
• Once stable, an upper GI endoscopy is performed where they can attempt to stop the bleeds with bands/clipping/haemostatin spray/adrenaline/heater probe

Question 4

What are some different scoring systems for upper GI Bleeding

Answer 4

• Rockall score
• Glasgow Blatchford score

Question 5

What bloods should be requested in an upper GI Bleed?

Answer 5

Haemoglobin,
Urea
Coagulation
LFTs,
Crossmatch

Question 6

When should you transfuse a patient with an upper GI bleed?

Answer 6

• Blood when Hb is under 7
• Give blood, platelets and FFP in massive haemorrhage,
• Platelets if platelet count is < 50
• Prothrombin complex concentrate and Vit K in patients who take warfarin and are actively bleeding

Question 7

What is the initial management of an upper GI bleed if oesophageal varices are suspected?

Answer 7

Terlipressin and broad spectrum antibiotics

Question 8

What factors are included in the Glasgow’s Blatchford score?

Answer 8

Blood urea,
Haemoglobin,
Systolic BP,
Pulse,
Presence of melaena,
Presence of syncope,
Heart failure,
Hepatic disease

Question 9

If a GI bleed hasn’t been successfully treated endoscopically then what can be performed?

Answer 9

Radiological emobolisation of bleeding vessel or a TIPS procedure if varices are suspected

Question 10

What is the prophylaxis and prevention for re bleeding varicies?

Answer 10

Beta blockers (carvediol) or band ligation

Question 11

What are some causes of lower GI bleeding?

Answer 11

• Vascular eg, ischaemic colitis, angiodysplasia.
• Inflammatory causes eg, IBD.
• Infective colitis,
• Neoplastic causes eg, colon cancer or anal cancer,
• Haemorrhoids or anal fissures,
• Diverticular disease, Meckel’s diverticulum
• Endometriosis

Question 12

What are the diagnostic tests for a lower GI bleed?

Answer 12

1. Bloods - assess Hb
2. Colonoscopy,
3. CT angiogram

Question 13

what is the management of a lower GI bleed?

Answer 13

1. Stabalise patient (same transfusion parameters as upper GI bleeds)
2. If unstable then do CT angiogram, if stable then colonoscopy
3. Surgery (laparotomy is source is unclear) or selective mesenteric embolisation

Question 14

When should you admit a patient with a lower GI bleed?

Answer 14

1. If over 60yo
2. Haemodynamically unstable or profuse PR bleeding
3. On aspirin or NSAIDs
4. Significant co-morbidity

Question 15

What are the indications for surgery in a patient with a lower GI bleed?

Answer 15

• Over 60yo
• Bleeding continues despire endoscopic intervention
• Recurrent bleeding
• Known CV disease