Acute upper GI bleeding

Question 1

When should acute upper GI bleeding be suspected?

Answer 1

• Haematemesis
• Melaena
• Coffee-ground vomit

Question 2

Name four aspects of a presentation for when variceal bleed should be suspected

Answer 2

• Previous variceal bleed/known varices
• Cirrhosis
• Jaundiced
• Ascites
• Spider naevi/palmar erythema
• Splenomegaly
• Platelets <100 (unless known other cause)

Question 3

Outline the resuscitation of haemodynamic instability

Answer 3

• Involve senior doctor NOW
• IV access
• Bloods
  
  • FBC, VBG, U+E, LFT, INR, Clotting, G+S
• X-match 6 units of RBC
• Monitor fluids and NEWS
• Consider
  
  • Transfusion if below target Hb
  • Reverse anticoagulation

Question 4

Outline the initial investigations for acute upper GI bleeding with haemodynamic stability

Answer 4

• IV access
• Bloods
  
  • FBC, VBG, U+E, LFT, Clotting
• X-match 2 units of RBC
• Consider
  
  • Reverse anticoagulation

Question 5

Outline the immediate treatment of variceal bleeds

Answer 5

• Terlipressin 2mg IV STAT
  
  • Continue as QDS for 72h
• Antibiotic prophylaxis for 72h
  
  • Coamoxiclav 1.2g IV TDS
  • If pen-allergic: Ciprofloxacin 500mg PO BD

Question 6

How is the acute upper GI bleeding risk assessed? What markers are used in this assessment?

Answer 6

Glasgow-Blatchford score to determine need for interventions such as transfusion and endoscopy.

• Urea
• Hb
• Systolic BP
• Other clinical markers
  
  • HR
  • Melaena
  • Syncope
  • Hepatic disease
  • Cardiac failure

Question 7

How does the outcome differ depending on the Glasgow-Blatchford score?

Answer 7

• If score = 0 and no other reason to admit
  
  • From ED: Discharge home and contact GP
  • Inpt: Continue routine care
• If score > 0
  
  • Admit (from ED) or Monitor (inpt)
  • Refer to GI team