Acute Gastrointestinal bleeding

20 flashcards · Other · by Anonymous Sloth

1. What is GI bleeding

   Upper GI bleeding oesophagus, stomach or duodenum Lower GI bleeding distal to duodenum, Jejunum, ileum, colon

2. Features of upper GI bleeding

   Haematemesis (vomitting blood) Melaena (dark sticky faeces) Elevated urea (haemorrhage -> urea) Associated symptoms: dyspepsia, reflux, epigastric pain NSAID use

3. Features of lower GI bleeding

   Fresh blood/ clots Magenta stools Normal urea levels Asymptomatic typically Common in older people

4. What are the causes of upper GI bleeds

   oesophagus ulceration Oesophagitis Varices mallory-weirs tear (tear at oesophagi-gastric junction) Malignancy Stomach Ulcer gastritis varices Portal hypertensive gastropathy Malignancy Dieulafoy (submucosal arteriolar vessel eroding through mucosa) Angiodyspasia (vascular malformation,) Duodenum Ulcer Duodenitis Angiodysplasia

5. Features of peptic ulcer in history taking

   Presenting complaint Dyspepsia Weight loss Medical history Liver disease Drug history Use of NSAIDs Steroids Anti-coagulants Antiplatelt agents Social history Alcohol Smoking Family history Peptic ulcers H pylori infection

6. Aetiology gastritis and duodenitis

   similar risk factor to gastric and duodenal ulcers Due to impaired coagulation Medical condition Anti-Coagulant therapy Anti-platelet therapy

7. Aetiology of oesophagitis

   Acid reflux Hiatus hernia Alcohol Bisphosphonates (osteoporosis drug) Systemic illness Significant bleeding occurs if on anti-platelet and anti-coagulation therapy

8. Investigations in upper GI bleeding

   Upper GI endoscopy Diagnostic and therapeutic Within 24 hours or sooner

9. What are the causes of acute lower GI bleeding

   Diverticular disease Haemorrhoids Vascular malformation Neoplasia (carcinoma or polyps) Ischaemic colitis Radiation enteropathy/ proctitis IBD (UC and CD)

10. What is diverticular ideas

    Protrusion of the inner mucosal layer through the outer muscular layer to form a pouch 'Diverts' faecal matter to a blind ended tube. Usually self limiting

11. What are haemorrhoids

    Ballooned distal vessels around the anal canal Caused by straining/ constipation/ low fibre diet Requires surgical intervention

12. What is angiodysplasia

    Vascular malformations that are degraded and break apart easily Bleeding can be mediated by anticoagulants and anti platelets drugs.

13. Describe colonic neoplasia

    Benign polys or malignant carcinomas Can often be asymptomatic Doesn't often cause life-threatening bleeding

14. Describe ischaemic colitis

    Reduced/disrupted perfusion to the colon Only affect blood supply to the according blood vessel Symptoms of cramps abdominal pain and sudden bleeding Self-limiting Mucosa is blue and swollen

15. Describe radiation proctitis

    Succeeding radiotherapy (cervical and prostate cancer)

16. What are the investigations for lower GI bleeding

    Flexible sigmoidoscopy Colonoscopy CT angiography

17. Describe small bowel involvement in lower GI bleeding

    5% lower GI bleeding caused by the small bowel Investigations CT angio Meckels scan Capsule endoscopy Double balloon enteroscopy

18. Describe the management of GI bleeding

    Monitor ABC endoscopy (once stable) Stop drugs that precipitate condition Blood products to replace lost blood

19. Describe shock

    Inadequate circulation to tissue leading to a mass hypo perfusion and tissue hypoxia

20. What is the management of peptic ulcers

    Proton pump inhibitor (decrease acid) Endoscopy with endotherapy Adrenaline Electrocautery Clip Haemospray Angiography with embolisation Laparotomy