[32] Upper GI Bleeding Flashcards
What is it important to know in the history in a patient with a upper GI bleed?
Previous bleeds Dyspepsia or known ulcers Liver disease, or oesophageal varices Dysphagia or weight loss Drugs and alcohol Co-morbidities
What may be found on examination in upper GI bleeding?
Signs of CLD
Signs of shock
What signs of shock might be seen on examination in upper GI bleeding?
Cool and clammy CRT >2s Decreased BP or postural hypotension Decreased urine output Tachycardia Decreased GCS
What might be found on PR in upper GI bleeding?
Melaena
What are the common causes of upper GI bleeding, in order
PUD Acute erosions/gastritis Mallory-Weiss tear Varices Oesophagitis Cancer of stomach or oesophagus
What kind of PUD more commonly causes upper GI bleeding?
DU
What is the purpose of a Rockall score?
Prediction of re-bleeding and mortality
What % of re-bleeders die in upper GI bleeds?
40%
What are the components to the Rockall score?
Initial
Final
When is the initial Rockall score calculated?
Before endoscopy
When is the final Rockall score calculated?
After endoscopy
What is taken into account in the initial Rockall score?
Age
Shock - BP and pulse
Co-morbidities
What is taken into account in the final Rockall score?
Final diagnosis, and evidence of recent haemorrhage
What evidence for recent haemorrhage might be seen on endoscopy?
Active bleeding
Visible vessel
Adherent clot
How can the Rockall score be used to guide surgery?
Initial score of 3 or more, or final score of 6 or more are indications for surgery
What is the pathophysiology of oesophageal varices?
Portal hypertension leads to dilated veins at the sites of porto-systemic anastomosis
What veins are affected in oesophageal varices?
Left gastric
Inferior oesophageal
What % of those with portal hypertension with bleed from varices?
30-50%
What is the overall mortality of oesophageal varices?
25%
What is the mortality from oesophageal varices dependant on?
The severity of liver disease
What are the categories of causes of portal hypertension?
Pre-hepatic
Hepatic
Post-hepatic