64. Upper GI bleed Flashcards
What are the common causes of a GI bleed?
Peptic ulc3s Mallory-Weiss tear Oesophageal varices Gastritis/gastric erosions Drugs (NSAIDs, aspirin, steroids, thrombolytics, anticoagulants) Oesophagitis Duodenitis Malignancy
What are rare causes of an Upper GI bleed?
Bleeding disorders
Portal hypertensive gastropathy
Aorta-enteric fistula
Angiodysplasia
Heamobilia (bleeding into the biliary tree)
Dieulafoy lesion (abnormally large artery in the GI tract)
Mickel’s diverticulum (outpouching of small intestine)
Peutz jeghers syndrome (benign polyps on the GI tract)
Osler Weber rendu syndrome (genetic blood vessel disorder)
What is involved in your initial management of those with a GI bleed?
Ask about co-morbidities (heart, rep and esp. liver disease)
PR exam
Looks for signs of shock- peripherally cool, reduced GCS, Tachycardia, systolic BP<100mmHg
Look for signs of liver disease
What scoring system is used to assess upper GI bleeds?
Rockall score:
Age Shock Co-morbidity Post endoscopy diagnosis Signs of recent heamorrhage
What is the acute management of upper GI bleeding?
Protect airway, give high flow oxygen Insert two large bore cannula Take bloods (CRP, U&E’s, LFT, Clotting and crossmatch) Monitor urine output CXR,ECG,ABG central venous line Transfuse Correct clotting factors
What can be given for suspected varices?
Terlipressin IV 1-2mg/6h for less than 3 days. (Vasopressor)
What is given to a peptic ulcer that has been bleeding but has now stopped?
IV esomeprazole, 3 doses (not superior?)
What are the causes of portal hypertension?
Pre-hepatic- thrombosis
Intra-hepatic- cirrhosis, schistosomiasis,sarcoidosis,congenital fibrosis
Post-hepatic- right heart failure, constrictive pericarditis,
How are gastro-oesophageal varices treated?
Endoscopic banding- oesophageal
Sclerotherapy- gastric
Prophylaxis- propranolol (20-40mg 12 hrly)
