Give some examples of causes of upper GI bleeding.
Oral cavity & nasopharynx
Oesophagus: tumour, Mallory-Weiss tear, varices
Stomach: tumour, ulcers, erosions, Dieulafoy’s lesion (tortuous arteriole), batteries
Duodenum: ulcers, haemobilia (iatrogenic)
Give some examples of causes of lower GI bleeding.
Small bowel: tumours, ulceration, IBD, Meckel’s diverticulum
Large bowel: tumours, diverticula, radiation damage, AV malformation/angiodysplasia, IBD, haemorrhoids, varices, vasculitis
Outline the management of upper GI bleeding.
- resuscitation & stabilisation
- Hx: alcohol, clotting disorders, malignancy, drugs (warfarin, NSAIDs, steroids)
- OGD +/- endoscopic intervention
- PPI +/- H. pylori eradication
- varices treatment
- surgery
What scoring system predicts the likelihood that a patient with an acute upper GI bleed will require intervention?
Glasgow-Blatchford score
- [urea]blood
- Hb
- systolic BP
- tachycardia
- melaena
- syncope
- hepatitc/CVS failure
What scoring system selects patients with upper GI bleeding for endoscopic intervention?
Forrest classification
Ia = spurting haemorrhage Ib = oozing haemorrhage
IIa = visible vessel IIb = adherent clot IIc = flat pigmented haematin on ulcer base
III = lesions without signs of recent haemorrhage or fibrin-covered clean ulcer base
What scoring system predicts the likelihood of adverse events following an upper GI bleed?
Rockall score
- age
- hypovolaemic shock (tachycardia, increased capillary refill, tachypnoea, oligouria)
- co-morbidities
- evidence of bleeding
- diagnosis
Describe the presentation and investigations in a lower GI bleed.
Minor bleed PR OR massive blood loss (collapse, palpitations, angina, MI)
Ix: BLOODS: - FBC - U&Es - LFTs - clotting - crossmatch
IMAGING:
- mesenteric angiogram (CT)
FUNCTIONAL:
- ECG
- sigmoidoscopy/colonoscopy
- mesenteric angiogram
Outline the general management of a lower GI bleed.
- resuscitation: 2 large bore cannulae, IV fluids, urinary catheter, O2
- conservative/radiological
- surgical
Give some examples of causes of GI perforation.
Upper GI: ulcers, cancer
Small bowel: cancer, foreign bodies, obstruction, trauma
Large bowel: diverticular disease, cancer, obstruction, IBD, iatrogenic, appendicitis
Outline the presentation of GI perforation.
- abdominal pain
- generalised peritonitis
- hyperdynamic circulation: tachycardia, pyrexia, flushed
- shock
What are the appropriate investigations in GI perforation?
BLOODS:
- FBC
- U&Es
- clotting
- crossmatch
- ABG
IMAGING:
- CXR/AXR: Rigler’s sign (double wall)
- CT: 5-10ml of air detectable
FUNCTIONAL:
- ECG
Outline the general management of GI perforation.
- resuscitation: IV fluids, O2, catheter, IV Abx, analgesia
- medical: Abx, bowel rest, TPN, PPI, radiological drainage of abscesses
- surgical: oversew upper GI perforation, resect small bowel/colonic perforation (stoma formation)
