Flashcards in GI haemorrhage (also see Gen med: acute GI bleed) Deck (27):
1
Name the cardinal features of acute upper GI bleeding
Haematemesis
Melaena
2
What is the commonest cause of Upper GI bleeding?
Peptic ulcers (50%)
3
Name 3 causes of Upper GI bleeding within the oesophagus
Mallory-Weiss syndrome
Oesophageal varices
Oesophageal tumours
Reflux oesophagitis
4
Name 3 causes of Upper GI bleeding within the stomach
Gastric ulcers
Gastritis/gastric erosions
NSAIDs
Gastric carcinoma
Corrosive substances e.g. batteries
Dieulafoy's lesion
5
What is Dieulafoy's lesion?
Calibre persistent artery - a large tortuous arteriole within the submucosa of the stomach.
Accounts for 1-2% of acute GI bleeding
6
Name 2 causes of Upper GI bleeding within the duodenum
Duodenal ulcers
Haemobilia
7
Name and describe 2 scoring systems used to assess acute Upper GI bleeding
Blatchford score: Determines the need for intervention. Score of 6+ indicates admission.
Rockall score: Predicts the risk of rebleeding and mortality after upper GI bleeding. Initial score of >6 indicates surgical intervention.
8
Outline the management of Upper GI bleeding in a haemodynamically stable patient (3)
Insert 2 large-bore cannulae
Start slow saline IVI
Check bloods, vitals, urine output
Consider transfusion if loss >30% circulating volume
9
Outline the initial medical management of Upper GI bleeding in a shocked patient (10)
Protect airway and keep NBM
Insert 2 large-bore cannulae
Urgent blood Ix, crossmatch 6 units
Rapid fluid resuscitation
Correct clotting abnormalities
Consider referral to ICU, and CVP line
Catheterise and monitor urine output
Monitor vitals every 15min till stable, then hourly
Notify surgeons of severe bleeds
Urgent endoscopy
10
What is the indication for surgical intervention of upper GI bleed?
Failure to control bleed using medical and endoscopic treatment
Rockall score >6
11
How common is acute lower GI bleeding compared to acute upper GI bleeding?
Acute lower GI bleeding is 1/5 as common
12
What are the 2 commonest causes of massive acute lower GI bleeding?
Diverticular disease
Ischaemic colitis
Angiodysplasia
13
Name the 3 causes of small acute lower GI bleeding
Haemorrhoids
Anal fissures
Colorectal cancer
IBD
Vasculitis
14
Outline the management of acute lower GI bleeding
Resuscitation
-2 large-bore cannulae
-IV fluid/blood resuscitation
-Urinary catheter
-Oxygen
Conservative and radiological treatment
Surgical treatment rarely needed
15
Define angiodysplasia
Vascular malformations of unknown aetiology, most frequently found in the right colon.
Occasionally associated with cutaneous and oral lesions
16
Outline the definitive management of angiodysplasia
Colonoscopic therapy (injection, heater probe, argon plasma coagulation)
Angiographic embolisation
Right hemicolectomy
17
How is lower GI bleeding due to angiodysplasia investigated?
Colonoscopy
Endoscopy
CT angiogram
Seen as cherry red flat lesions
18
Describe the presentation of acute anorectal bleeding
Bright red blood, on the surface of stool and paper, after defecation
19
Name 3 causes of acute anorectal bleeding
Haemorrhoids
Acute anal fissure
Distal proctitis
Rectal prolapse
20
Describe the presentation of acute rectosigmoid bleeding
Darker red blood, with clots, in surface of stool and mixed in stool
21
Name 2 causes of acute rectosigmoid bleeding
Rectal tumours
Proctocolitis
Diverticular disease
22
Describe the presentation of acute proximal colonic bleeding
Dark red blood mixed into stool or altered blood (malaena)
23
Name 3 causes of acute proximal colonic bleeding
Colonic tumours
Colitis
Angiodysplasia
NSAID-induced ulceration
24
What is suggested by acute rectal bleeding and LIF tenderness?
Diverticular inflammation with bleeding
25
What is the definitive management for the majority of anorectal causes of low GI bleeding?
Local measures: injection, coagulation, packing
26
Outline the definitive management for lower GI bleeding due to acute colitis
IV or PO metronidazole if thought to be infective cause - until advice by microbiology
Angiographic embolisation
Directed hemicolectomy if location of bleeding known
Subtotal colectomy (removal of colon, with rectum intact) if location is unknown
27