8.4 Upper GI Bleeding

Question 1

AUGIB

Answer 1

Acute Upper GI Bleeding

Question 2

Most common cause of GIB

Answer 2

Peptic ulcer (non-variceal upper GIB)

Question 3

Clinical menifestatioms

Answer 3

Hematemasis
Coffee-grounds vomiting
Black and tarry stool (melena)

Question 4

Melana

Answer 4

Black and tarry stool

Question 5

Clinical manifestations:
(BUN) Blood urea nitrogen levels, blood pressure, pulse
increase/decrease

Answer 5

Bun increase
BP decrease
Pulse increase

Question 6

PR exam
Purpose
Position

Answer 6

Per rectal exam
Check for stool color
Left lateral

Question 7

Malory-Weiss tear

Answer 7

Esophageal gastric junction have bleeding

Question 8

Management of AUGIB aims

Answer 8

Stop bleeding
Restore CV stability by volume resuscitation
Prevent recurrent bleeding

Question 9

Golden standard

Answer 9

Endoscopic therapy

Question 10

Aims of assessment on first stage of pre-endoscopic treatment

Answer 10

To determine etiology and/or complications related to

Question 11

Normal adult U/O

Answer 11

> =30mL/min

Question 12

At least __ __-__G IV cannula

Answer 12

Two 16-18G

Question 13

Why Restrictive transfusion

Answer 13

Less recurrent bleeding
(<=7-8g/dL Hb)

Question 14

Risk assessment tools
Aims

Answer 14

Glasgow blatchford score GBS
- use of triaging tools
<1 discharge with outpatient endoscopic, >7 urgent treatment
Rockall score RS
- risk of recurrent bleeding

Question 15

Injection therapy inject what

Answer 15

Epinephrine +saline in 1:10000
Recommend dual treatment

Question 16

Endoscopic haemostasis for NVGIB

Answer 16

injection therapy
Thermal coagulation
Mechanical therapy
Haemospray therapy

Question 17

Mechanical therapy:
Haemoclip in-situ for at least __-__days

Answer 17

7-10

Question 18

How is Haemospray therapy

Answer 18

Haemostatic powder adherence to bleeding site

Question 19

Standard practice of post-endoscopic management of UGIB

Answer 19

High-dose Intravenouse PPI
Use as adjunct therapy

Question 20

Example of PPI

Answer 20

Losec
Takepron
Pantoloc
Pariet
Nexium

Question 21

Bolus
(Infusion 80mg iv bolus)

Answer 21

一次過打曬

Question 22

Alternative treatment :
indication
Example

Answer 22

Failure of endoscopic haemostasis
Massive bleeding
unresponsive to treatment
Rebleeding

E.g. TAE Transcatgeter arterial embolization

Question 23

TAE

Answer 23

Inserted catheter via femoral artery
Apply Embolic agent e.g. Gelfoam

Question 24

Health education of discharge

Answer 24

• monitor s/s of recurrent bleeding (e.g. coffee ground vomiting, black and tarry stool/melena)
• complete full course medication of antibiotic
• lifestyle modification
• follow up endoscopy after 6-8 weeks if prescribed
• regular follow-up