GI Bleeds

Question 1

four clinical presentations of upper GI bleeds - describe the location of where they would occur:

1. haematemesis
2. bleeding PR
3. melena
4. coffee ground vomiting

Answer 1

1. fresh red blood vomiting from upper GI origin
2. fresh red blood from lower GI origin
3. digested blood from upper GI origin
4. lower upper GI bleed - acted upon by stomach acid and been there for longer.

Question 2

how much blood do you have to lose to be haemodynamically unstable?

how will this present in:

• children
• old and frail

what bpm and systolic BP?

Answer 2

500ml

• children: just tachycardic as it takes a lot for them to be hypotensive
• old and frail: tachycardic and low BP

> 100bpm + <100mmHg

Question 3

if someone has stopped producing melena - have they stopped bleeding?

Answer 3

yes - as blood is a good laxative

Question 4

what Ix would you do for a GI bleed?

what fluids would you give if they are haemodynamically unstable?

what is your next step if the patient is on anticoagulation?

Answer 4

FBC, U+E, LFT,
Group + Save

Hartmann’s

stop it and reverse it if on warfarin (give Vit k)

Question 5

Why do you need to look at the urine output if they are a GI bleed patient?

whats a normal urine output?

Answer 5

to see if there is enough circulatory replacement ( will pass urine if they have enough fluid)

> 35ml/hour

Question 6

Most common causes of UPPER GI bleeds?

if a 30 yr old w/ haematemesis
if a 70 yr old w/ haematemesis

Answer 6

1. peptic ulcers (40%)
2. gastritis (28%)
3. oesophageal varices (14%)
4. oesophagitis

= most likely oesophageal varices.
= most likely peptic ulcer.

Question 7

Most common causes of LOWER GI Bleeds?

Answer 7

1. Diverticular Disease (most common)
2. Polyps
3. Malignancy (mostly rectum)
4. IBD
5. Ischaemic colitis

Question 8

Questions to ask for peptic ulcer:

Answer 8

Alcohol abuse
Smoking
H. pylori infection
NSAIDs