Acute Gastro-Intestinal Bleed / Upper GI bleed Flashcards
What is the epidemiology of an upper GI bleed?
More common in males.
What are the causes of an upper GI bleed?
- Peptic ulcer disease (commonest)
- Variceal haemorrhage
- Gastroduodenal erosions
- Mallory-Weiss tears
What is the prognosis for an upper GI bleed?
5-12% mortality due to ↑ elderly with co-morbidities
What are the 2 groups fo patients associated with an upper GI bleed?
- Variceal lesions (either oesophageal or gastric).
2. Non-variceal lesions (most commonly peptic ulcers)
What are the risk factors associated with an upper GI bleed?
Underlying disorders:
- Bleeding disorders.
- Chronic liver disease.
- Alcohol use.
Medications:
- NSAIDs.
- Steroids.
- Anti-coagulants.
H Pylori infection.
What are the signs and symptoms associated with an upper GI bleed?
- Nausea and vomiting. -
- Melaena.
- Epigastric pain.
- Heartburn.
- Weight loss and night sweats.
- Signs of chronic liver disease.
- Haemodynamic shock.
What investigations are undertaken when a peptic ulcer is suspected?
- FBC and coagulation profile.
- Group and save and cross-match blood.
- U&Es.
- Abdominal CT.
- Endoscopy.
What 2 scores are associated with an upper GI bleed?
- Rockall risk score – assess risk of rebleeding or death.
2. Glasgow-Blatchford bleeding score (GBS) – assess need for intervention e.g. endoscopy, transfusion.
What are the differential diagnoses?
- Peptic ulcer disease.
- Oesophageal varices.
- Oesophagitis.
- Mallory-Weiss tear.
- Boerhaave syndrome
- AVM’s (arteriovenous malformation).
- Upper GI tumour.
What are the treatment options for an upper GI bleed?
- Fluids and RBC/FFP.
- Vasopressors if severe.
- Catheter.
- Endoscopy/Surgery to stop source of bleeding.
- Stop NSAID’s, warfarin etc. that could cause bleed.
What complications can occur?
- Anaemia.
- Hypovolaemia.
- Shock.
- Dehydration.
