UpperGI- Bleeding

Question 1

What is haematemesis and malaena?

Answer 1

1. Haematemesis- Vomiting blood
2. Malaena- dark sticky blood consisting of partly digested blood, maybe due to internal bleeding.

Question 2

With regards to ABC, what interventions are important in a haemorrhage?

Answer 2

Airway protection

Oxygen

IV access

fluids

Question 3

What is the “100 rule” when it comes to assessing severity of haemorrhage?

Answer 3

1. Systolic BP <100mmHg
2. Pulse > 100/min
3. Hb <100g/l
4. Age > 60
5. Commorbid disease
6. Postural hypotension

Question 4

What immediate investigation is undertaken following resuscitating a haemorrhagic patient?

Answer 4

Endoscopy

Question 5

What phyiscal features in endoscopy can suggest a haemorrhage?

Answer 5

1. Active bleeding/oozing
2. Clot formation
3. Visible vessel

Question 6

What are the treatment options for peptic uclers?

Answer 6

1. Endoscopic treatment
2. Acid suppression by drugs
3. Surgery
4. H. pylori eradication

Question 7

What are the subtypes of endoscopic treatment for bleeding ulcers?

Answer 7

1. Injection
2. Heater probe coagulations
3. Combinations
4. Clips
5. Haemospray

Question 8

What is injected in patients with endoscopic treatments?

Answer 8

Adrenaline

Question 9

How does a haemospray work?

Answer 9

Haemospray contains a powder. When in contact with the blood, it absorbs the water then forms a protective barrier over the bleeding site.

Question 10

Which drug is 1st line for acid suppression in bleeding?

Answer 10

IV Omeprazole

Question 11

If endoscopic treatment followed by acid inhibition fails to stop and prevent further bleeding, what is the next treatment option?

Answer 11

Surgery

Question 12

Define oesophageal Varises?

Answer 12

Dilated veins of the oesophagus

Question 13

What condition is the biggest risk factor for Variceal bleeding?

Answer 13

Liver Cirrhosis

Question 14

What is the pathogenesis of Variceal bleeding?

Answer 14

1. Liver disease- Cirrhosis
2. Portal hypertension
3. Backflow of blood into oesophageal veins
4. Oesophageal veins anastamose together
5. Pooling of blood around oesophagus
6. Increased blood causes veins to dilate
7. Eventually they burst- Rupture

Question 15

What conditions in the history can suggest variceal bleeding?

Answer 15

1. Known cirrhosis
2. Chronic alcohol ecxess
3. Viral hepatitis infection
4. Metabolic/autoimmune liver disease
5. Intrabdominal sepsis

Question 16

What investigations and things need to be considered before treating variceal bleeding?

Answer 16

1. Coagulopathy (FFP/Platelets/ Vitamin K)
2. Central venous pressure
3. Parenteral vitamins
4. Hypoglycaemia.

Question 17

1st line drug intervention for Variceal bleeding?

Answer 17

Terlipressin- Splanchnic vasoconstrictor. Also has beneficiary effect on renal perfusion

Question 18

What is endoscopic variceal ligation?

Answer 18

Wrapping a rubber band around the varices using an endoscope. Reduces bleeding.

Question 19

What is sclerotherapy

Answer 19

Injection of an irritant that causes inflammaiton–> coagualtion of blood–> narrowing of the blood vessel wall.

Question 20

What is the application of the Sengstaken-Blakemore tube?

Answer 20

In endoscopy a plastic tube inserted with it which deploys a balloon stent which inflates in the stomach. This compresses the gastro-oesophageal junction, reducing blood flow to the oesophageal varices.

Question 21

How does TIPPS help in variceal bleeding?

Answer 21

Stent is deployed into a liver vein. The inflated stent forms a channel or shunt that bypasses the liver. This reduces portal hypertension, reducing chances of variceal bleeding and rupture.