GI haemorrhage (also see Gen med: acute GI bleed) Flashcards Preview

Phase II: Periop Pt1 > GI haemorrhage (also see Gen med: acute GI bleed) > Flashcards

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

Name a classification system used to risk stratify upper GI bleeds with ulceration

Forrest classification: used to asses the need for endoscopic intervention in ulcerative upper GI bleeding