Acute Upper Gastrointestinal Bleeding Flashcards

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1
Q

What are the causes of acute upper gastrointestinal bleeding?

A
  • Peptic ulcer disease
  • Gastroduodenal erosions
  • Oesophagitis
  • Mallory-Weiss tear
  • Varices
  • Upper GI malignancy
  • Vascular malformations
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2
Q

What are the potential sources of swallowed blood?

A
  • Facial trauma
  • Nose bleed
  • Haemoptysis
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3
Q

What are the symptoms of an upper GI bleed?

A
  • Haematemesis
  • Melaena
  • Dizziness
  • Fainting
  • Abdominal pain
  • Dysphagia
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4
Q

What are the signs of acute upper gastrointestinal bleeding?

A
  • Hypotension (in young people, likely to be postural only)
  • Tachycardia
  • Decreased JVP
  • Decreased urine output
  • Cool and clammy
  • Signs of chronic liver disease
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5
Q

Give three signs of chronic liver disease

A
  • Telangiectasia
  • Purpura
  • Jaundice
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6
Q

What should the focus be on in the management of acute upper GI bleeding?

A

Circulation

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7
Q

Give an example of a method of risk stratification in acute upper GI bleeding?

A

Rockall score

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8
Q

What are the signs that a patient with an acute upper GI bleed is shocked?

A
  • Peripherally cool/clammy
  • Capillary refill time >2s
  • Urine output <0.5mL/kg/h
  • Decreased GCS or encephalopathy
  • Tachycardic
  • Systolic BP <100mHg, or postural drop of >20mmHg
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9
Q

How is a patient in shock following an acute upper GI bleed managed?

A
  1. Protect airway, and keep NBM
  2. Insert two large-bore cannulae
  3. Urgent bloods
  4. If signs of grade III or IV shock, give blood. Otherwise, continue IV fluids to maintain BP, and transfuse, e.g. if Hb <70
  5. Correct clotting abnormalities
  6. Consider referral to ICU or HDU, and consider CVP line to guide fluid replacement
  7. Catheterise and monitor urine output
  8. Monitor vital signs every 15 minutes until stable, then hourly
  9. Notify surgeons of all severe bleeds
  10. Urgent endoscopy at earliest possible point after adequate resuscitation
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10
Q

What urgent bloods should be done when a patient is in shock following an acute upper GI bleed?

A
  • FBC
  • U&E
  • LFT
  • Glucose
  • Clotting screen
  • Blood typing
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11
Q

What blood type should be given to patients with grade III or IV shock with acute upper GI bleeding?

A

Group specific, or O -ve until crossmatch done

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12
Q

How are clotting abnormalities corrected in a shocked patient following an acute upper GI bleed?

A
  • Vitamin K
  • FFP
  • Platelet concentrate
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13
Q

What central venous catheter pressure should be aimed for in a shocked patient following an acute upper GI bleed?

A

>5cmH2O

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14
Q

When might the CVP result be misleading?

A

Ascites or CCF

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15
Q

What urinary output should be aimed for in a shocked patient following upper GI bleeding?

A

>30mL/h

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16
Q

Why is an urgent endoscopy required in shocked patients with acute upper GI bleeding?

A

Diagnosis, with or without control of bleeding

17
Q

In what situations should you avoid giving saline as the fluid in volume restoration after acute upper GI bleeding?

A

Cirrhosis/varices

18
Q

Give two examples of things that would give rise to suspicion of varices in a patient with acute upper GI bleeding

A
  • Known history of liver disease
  • Alcohol excess
19
Q

What should be done in a patient with acute upper GI bleeding and suspicion of varices?

A
  • IV terlipressin (1-2mg/6h for 3 days)
  • Broad-spectrum IV antibiotics
20
Q

What can be done if endoscopic control of upper GI bleeding fails?

A

Surgery or emergency mesenteric angiography/embolisation

21
Q

What can be used in uncontrolled oesophageal variceal bleeding?

A

Sengstaken-Blakemore tube

22
Q
A