Gastrointestinal > GI Bleeds > Flashcards

GI Bleeds Flashcards

(36 cards)

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1
Q

Causes of upper GI bleeds

A
  • peptic ulcer (most common)
  • angdysplasia
  • Mallory Weiss teat
  • Boerhaave syndrome
  • oesophageal varices
  • gastric or oesophageal cancers
  • gastritis or oesophagitis
  • dieulafoy lesion
  • aortoenteric fistula
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2
Q

Presentation of upper GI bleed

A
  • haematemesis
  • coffee grounds vomit
  • malaena
  • abdominal pain
  • haemodynamic instability > tachycardia, hypotension, signs of shock
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3
Q

Why do upper GI bleeds cause coffee ground vomit?

A

Due to vomiting digested blood

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4
Q

What is melaena?

A

Tar like black greasy offensive stools due to digested blood

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5
Q

What is a Mallory Weiss tear?

A

Tear in the oesophageal mucosa
Occurs after heavy vomiting

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6
Q

What is boerhaave syndrome?

A

Spontaneous rupture of oesophagus
Secondary to severe vomiting episodes

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7
Q

What is a dieulafoy’s lesion?

A

Dilated arterial vessel that bleeds intermittently

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8
Q

What are aortoenteric fistulas?

A

Abnormal connection between aorta + GI tract
(Life threatening)

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9
Q

What is Gasglow Blatchford score used for?

A
  • Used in initial presentation in suspected GI bleed
  • risk of patient having an upper GI bleed
  • calculated before endoscopy
  • score >0 suggests bleed
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10
Q

Why do upper GI bleeds cause a raise in blood urea?

A

Acid + digestive enzymes break down blood in the upper GI tract
One of the breakdown products is urea > absorbed into intestines > increase in blood urea

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11
Q

What is the Rockall score used for?

A

used after endoscopy to estimate risk of re bleeding + mortality

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12
Q

General management of upper GI bleeds

A

ABATED
- ABCDE
- Bloods: FBC, U&E, clotting, LFT, G&S, clotting 2 units
- Access: 2 large bore cannla
- Transfusion: platelets, FFP, prothrombin complex concentrate
- Endoscopy within 24 hours
- Drugs - stop anticoagulant + NSAIDs.
.
- non variceal bleeding: clips or thermal coagulation + PPI - PPI after endoscopy
- variceal bleeding: variceal band ligation

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13
Q

Additional management of GI bleed is oesophageal varices are suspected

A

Terlipressin
Broad spec abx

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14
Q

What are peptic ulcers

A

Ulceration of the mucosa of the stomach or proximal duodenum (most common)

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15
Q

Risk factors of peptic ulcer

A
  • distrupts mucus barrier: H.pylori, NSAIDs
  • increase stomach acid: stress, alcohol, spicy foods, caffeine, smoking
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16
Q

What increases the risk of bleeding from a a peptic ulcer?

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A
  • NSAIDs
  • aspirin
  • anticoagulants
  • steroids
  • SSRIs
17
Q

Presentation of peptic ulcers

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A
  • epigastric pain
  • N+V
  • dyspepsia
18
Q

How can you differentiate between gastric + duodenal ulcers?

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A
  • gastric ulcers worsen on eating > weight loss due to avoiding eating
  • duodenal ulcers improve immediately after eating + worsened 2-3 hours later > weight is stable
19
Q

Diagnosis of peptic ulcers

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A
  • Endoscopy
  • Rapid urease test during endoscopy
  • Biopsy to exclude malignancy
20
Q

Management of peptic ulcers

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A
  • stop NSAIDs
  • treat H pylori - PPI + 2 abx for 14 days e.g. omeprazole + amoxicillin + clarithromycin
  • PPIs
  • reduce stress, smoking, alcohol
  • repeat endoscopy at 4 weeks
21
Q

Complications of peptic ulcer

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A
  • bleeding
  • perforation + peritonitis
  • scarring + strictures > gastric outlet obstruction
22
Q

Outline angiodysplasia

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A
  • most common vascular abnormality of GI tract
  • formation of arteriovenous malformations
  • most commonly in caecum + ascending colon
23
Q

What is the preferred imaging choice for small bowel angiodysplasia?

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A

Capsule endoscopy

24
Q

Managment of angiodysplasia

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A
  • managed endoscopically using argon plasma coagulation
  • mesenteric angiography with super-selective catheterisation + emobilisation (if endoscopy not accessible)
25
Causes of lower GI bleeds
- **diverticulosis** (most common large bleed) - **haemorrhoids** (most commonly small bleed) - anal fissures - UC + crohn’s - malignancy - angiodysplasia - radiation proctitis - infective colitis
26
Presentation of lower GI bleeding
- haematochezia - abdominal pain ?
27
Investigations of lower GI bleeds
- bloods: FBC, U&E, LFT, clotting, G&S - stool culture - **CT angiogram** - colonoscopy
28
Management of lower GI bleeds
- urgent resuscitation - Hb <70 require blood transfusion - reversal + stoppage of anticoagulants - endoscopic haemostasis methods - arterial embolisation
29
What are haemorrhoids?
Pathologically swelling vascular anal cushions
30
Risk factors of haemorrhoids
- excessive straining - chronic constipation - increasing age - raised intra-abdominal pressure *e.g. pregnancy, ascites, chronic cough, weight lifting*
31
Presentation of haemorrhoids
- painless bright red rectal bleeding - blood on paper or suface of stools - not mixed in - anal Pruritus - anal lump
32
What does a thromboses prolapsed haemorrhoid look like?
Purple/blue oedematous, tender perianal mass
33
Classification of haemorrhoids
- **1st degree**: no prolapse - **2nd degree**: prolapse when straining but spontaneously reduce on relaxing - **3rd degree**: prolapse on straining but do not reduce on relaxing - requires digital reduction - **4th degree**: prolapsed permanently
34
Investigations of haemorrhoids
- PR exam - proctoscopy - colonoscopy to exclude other pathology
35
Management of haemorrhoids
- most management is conservative - increase fibre + fluid intake - using laxatives when required - avoid straining - topical treatments *e.g. anusol, germaloid cream (lidocaine)* - 1st + 2nd degree: **rubber band ligation** - 2nd or 3rd degree: **haemorrhoidal artery ligation** - 3rd or 4th degree: **haemorrhoidectomy**
36
What are thromboses haemorrhoids caused by?
Due to strangulation at the base of the haemorrhoid
Gastrointestinal
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