GI bleed

• What is the anatomical site which distinguishes upper from lower GI bleed?

  Suspensory ligament of the duodenum (ligament of Treitz)
• What are the two presentations of upper GI bleed?

  Haematemesis

  Malaena
• What is the clinical presentation of lower GI bleed?

  Haematochezia
• What are three clinical manifestations of both upper and lower GI bleed?

  Anaemia

  Abdominal pain

  Signs of hypovolaemic shock
• What is haematemesis?

  Vomiting of blood which is obviously red or looks like coffee grounds when partially digested.
• What is malaena?

  Black tarry stools with a characteristic smell and appearance due to digestion of haemoglobin by digestive enzymes and intestinal flora.
• What is haematochezia?

  Fresh blood per anus usually in or with stools.
• Give 4 causes of bleeding originating from the oesophagus

  Oesophageal varices

  Oesophagitis

  Oesophageal cancer

  Mallory-weiss tear
• Give 5 causes of GI bleeding from the stomach

  Peptic ulcer disease

  Gastric varices

  Dieulafoy's lesion

  Angiodysplasia

  Foreign body ingestion
• Give two causes of duodenal bleed

  Peptic ulcer disease

  Angiodysplasia
• Give 3 causes of jejenul/ileal bleed

  Crohn's disease

  Inflammatory diarrhoea (shigella)

  Angiodysplasia
• Give 10 causes of colon or rectal bleeding

  Diverticular disease

  Crohn's disease

  Ulcerative colitis

  Proctitis

  Colon cancer

  Colonic polyps

  Angiodysplasia

  Inflammatory diarrhoea (shigella)

  Ischaemic colitis

  Mesenteric ischaemia
• Give 4 causes of anal bleeding

  Haemorrhoids

  Anal fissure

  Rectal cancer

  Trauma
• What is the general management of upper GI bleed?

  A-E

  Oesophago-gastroduodenoscopy as a diagnostic tool and therapeutic - put in haemostatic clips

  PPI in peptic ulcer disease
• What is the specific management of oesophageal varices?

  Terlipressin

  Broad spectrum antibiotics

  Band ligation during OGD
• Give the two scoring tools in upper GI bleed and state when they are used

  Glasgow-blatchford score - pre-endoscopu

  Rockall score - post-endoscopy
• Give the management of lower GI bleed

  A-E

  Colonoscopy - diagnostic and therapeutic - electrocautery

  Angiography is considered when colonoscopy fails or the patient is haemodynamically unstable.