GI bleeding differentials

• Causes of UGIB:

  • Oesophageal varices
  • Oesophagitis
  • Oesophageal cancer
  • Mallory-Weiss tear
  • PUD
  • Gastric varices
  • Gastric cancer
  • Angiodysplasia - vascular malformation
• UGIB management:

  • ABCDE approach - resuscitate with blood products if needed
  • Bloods - FBC, U+Es, LFTs, coagulation, G+S
  • Glasgow-Blatchford score (rockall after endoscopy)
  • OGD - immediate if unstable or within 24 hours
  • Variceal bleed - terlipressin and prophylactic antibiotics
• LGIB management:

  • ABCDE approach - resuscitate with blood products if needed
  • Colonoscopy for diagnosis and management usually within 24 hours
  • CT angiography to locate source of bleed if colonoscopy fails
• Causes of LGIB:

  • IBD
  • Inflammatory diarrhoea e.g. shigella
  • Angiodysplasia
  • Diverticular disease
  • Proctitis
  • Malignancy - colon, rectal
  • Colonic polyps
  • Ischaemic colitis
  • Mesenteric ischaemia
  • Haemorrhoids, anal fissure
• Gastrointestinal (GI) bleeding can be categorised into two main types: upper and lower. The anatomic landmark that distinguishes the two is the suspensory ligament of the duodenum (Ligament of Treitz).
• Bleeding originating proximal to the ligament of Treitz is classified as ‘upper GI bleeding’ and typically presents with haematemesis or melaena.
• Bleeding distal to the ligament is classified as ‘lower GI bleeding’ and commonly presents with haematochezia.
• Glasgow-Blatchford bleeding score pre-endoscopy:

  • Haemoglobin
  • BUN
  • Initial systolic BP
  • Sex
  • Heart rate >100
  • Melena present
  • Syncope
  • Hepatic disease history
  • Cardiac failure present