Flashcards in GI haemorrhage (also see Gen med: acute GI bleed) Deck (27):
Name the cardinal features of acute upper GI bleeding
What is the commonest cause of Upper GI bleeding?
Peptic ulcers (50%)
Name 3 causes of Upper GI bleeding within the oesophagus
Name 3 causes of Upper GI bleeding within the stomach
Corrosive substances e.g. batteries
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
Name 2 causes of Upper GI bleeding within the duodenum
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.
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
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
What is the indication for surgical intervention of upper GI bleed?
Failure to control bleed using medical and endoscopic treatment
Rockall score >6
How common is acute lower GI bleeding compared to acute upper GI bleeding?
Acute lower GI bleeding is 1/5 as common
What are the 2 commonest causes of massive acute lower GI bleeding?
Name the 3 causes of small acute lower GI bleeding
Outline the management of acute lower GI bleeding
-2 large-bore cannulae
-IV fluid/blood resuscitation
Conservative and radiological treatment
Surgical treatment rarely needed
Vascular malformations of unknown aetiology, most frequently found in the right colon.
Occasionally associated with cutaneous and oral lesions
Outline the definitive management of angiodysplasia
Colonoscopic therapy (injection, heater probe, argon plasma coagulation)
How is lower GI bleeding due to angiodysplasia investigated?
Seen as cherry red flat lesions
Describe the presentation of acute anorectal bleeding
Bright red blood, on the surface of stool and paper, after defecation
Name 3 causes of acute anorectal bleeding
Acute anal fissure
Describe the presentation of acute rectosigmoid bleeding
Darker red blood, with clots, in surface of stool and mixed in stool
Name 2 causes of acute rectosigmoid bleeding
Describe the presentation of acute proximal colonic bleeding
Dark red blood mixed into stool or altered blood (malaena)
Name 3 causes of acute proximal colonic bleeding
What is suggested by acute rectal bleeding and LIF tenderness?
Diverticular inflammation with bleeding
What is the definitive management for the majority of anorectal causes of low GI bleeding?
Local measures: injection, coagulation, packing
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
Directed hemicolectomy if location of bleeding known
Subtotal colectomy (removal of colon, with rectum intact) if location is unknown