GI bleeding & diverticular disease flashcards
19 high-yield MRCP Part 1 cards from the Intellect Medicos Gastroenterology & Hepatology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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In upper GI bleeding, use the ______ score at first assessment and the full Rockall score after endoscopy.
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Glasgow–Blatchford
Why? Blatchford (urea, Hb, BP, pulse, melaena, syncope, liver disease, heart failure) predicts need for intervention; Rockall needs endoscopic findings to predict rebleeding and death.
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In upper GI bleeding, use the Glasgow–Blatchford score at first assessment and the full ______ score after endoscopy.
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Rockall
Why? Blatchford (urea, Hb, BP, pulse, melaena, syncope, liver disease, heart failure) predicts need for intervention; Rockall needs endoscopic findings to predict rebleeding and death.
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Should a PPI be given BEFORE endoscopy for suspected non-variceal upper GI bleeding (NICE)?
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No. Give a PPI after endoscopy if there are stigmata of recent haemorrhage.
Why? Pre-endoscopy PPI does not improve mortality, rebleeding or surgery rates.
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Why should adrenaline injection not be used alone for endoscopic treatment of a bleeding peptic ulcer?
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Adrenaline monotherapy has a high rebleeding rate; combine it with a mechanical (clips), thermal or fibrin/thrombin method.
Why? Adrenaline only causes temporary vasoconstriction and tamponade; the second method secures the vessel.
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NICE upper GI bleed: give platelets if actively bleeding with platelets below ______; give FFP if PT/INR or APTT is more than 1.5 times normal.
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50 × 10⁹/L
Why? Over-transfusion can be as harmful as under-transfusion, so products are given against thresholds. Red cells follow a restrictive strategy once massive bleeding is controlled (transfuse below about 70 g/L, target 70–90 g/L).
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NICE upper GI bleed: give platelets if actively bleeding with platelets below 50 × 10⁹/L; give FFP if PT/INR or APTT is more than ______ normal.
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1.5 times
Why? Over-transfusion can be as harmful as under-transfusion, so products are given against thresholds. Red cells follow a restrictive strategy once massive bleeding is controlled (transfuse below about 70 g/L, target 70–90 g/L).
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What is given to a patient on warfarin who has an active upper GI bleed?
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Prothrombin complex concentrate (PCC) plus IV vitamin K.
Why? PCC replaces factors II, VII, IX and X within minutes; vitamin K sustains the reversal.
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Which reversal agent does NICE recommend for life-threatening GI bleeding on apixaban or rivaroxaban?
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Andexanet alfa.
Why? It is a modified factor Xa decoy that binds the factor Xa inhibitor, freeing the patient's own factor Xa.
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Which TWO drug treatments are started at presentation for a suspected variceal bleed?
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Terlipressin and prophylactic antibiotics.
Why? Terlipressin lowers portal pressure; antibiotics reduce infection, rebleeding and death in cirrhosis.
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What is the mechanism of action of terlipressin?
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A vasopressin analogue that causes splanchnic vasoconstriction (V1 receptors), reducing portal blood flow and pressure.
Why? Less blood reaches the portal system, so variceal pressure falls. The same effect improves renal perfusion in hepatorenal syndrome.
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Bleeding oesophageal varices are treated endoscopically with ______; bleeding gastric varices with injection of N-butyl-2-cyanoacrylate (tissue glue).
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band ligation
Why? Banding beats sclerotherapy for oesophageal varices; gastric varices are too large and deep to band.
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Bleeding oesophageal varices are treated endoscopically with band ligation; bleeding gastric varices with injection of ______.
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N-butyl-2-cyanoacrylate (tissue glue)
Why? Banding beats sclerotherapy for oesophageal varices; gastric varices are too large and deep to band.
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Under NICE NG50, what is offered first for PRIMARY prevention of bleeding from medium or large oesophageal varices in cirrhosis?
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A non-selective beta-blocker: carvedilol or propranolol. Band ligation is used if these are not tolerated, are contraindicated, or the person cannot take tablets reliably.
Why? Non-selective beta-blockers lower portal pressure; NICE found them as effective as banding and more cost effective, and most people prefer tablets to repeated endoscopy. Carvedilol is preferred because it has extra alpha-1 blockade and a greater effect on portal pressure.
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What is the first-line investigation for suspected acute diverticulitis needing imaging?
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CT abdomen with IV contrast.
Why? It confirms inflamed diverticula with wall thickening and fat stranding and shows complications (abscess, perforation, fistula).
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What is the first-choice oral antibiotic for acute diverticulitis in a patient who is systemically unwell (NICE)?
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Co-amoxiclav for 5 days.
Why? It covers gut Gram-negatives and anaerobes. Penicillin-allergic options: cefalexin + metronidazole or trimethoprim + metronidazole.
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How is a diverticular abscess of 3 cm or more managed?
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CT-guided percutaneous drainage plus IV antibiotics.
Why? Smaller abscesses (under 3 cm) usually settle with IV antibiotics alone; perforation or peritonitis needs emergency surgery (Hartmann's or resection with anastomosis).
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Where in the gut does angiodysplasia most often occur?
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The caecum and ascending colon.
Why? The high wall tension of the right colon is thought to cause chronic obstruction of submucosal veins, leading to vascular ectasia. It is the commonest vascular cause of lower GI bleeding in the elderly.
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Heyde's syndrome is aortic stenosis with bleeding angiodysplasia: shear stress across the valve cleaves large von Willebrand multimers, causing acquired ______. Definitive treatment is aortic valve replacement.
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type 2A von Willebrand disease
Why? Loss of high-molecular-weight vWF multimers impairs platelet adhesion, so the fragile vessels bleed. Replacing the valve stops the shear and the bleeding often settles.
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Heyde's syndrome is aortic stenosis with bleeding angiodysplasia: shear stress across the valve cleaves large von Willebrand multimers, causing acquired type 2A von Willebrand disease. Definitive treatment is ______.
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aortic valve replacement
Why? Loss of high-molecular-weight vWF multimers impairs platelet adhesion, so the fragile vessels bleed. Replacing the valve stops the shear and the bleeding often settles.