Acute Upper GI bleeding

Question 1

Risk assessment

Answer 1

Blatchford score at first assessment

Full Rockall score after endoscopy

Question 2

Components of Blatchford Score

Answer 2

Urea- mmol/l
Haemoglobin (g/L)
Systolic BP
Other markers

Question 3

Which Blatchford score can be considered for early discharge

Answer 3

0

Question 4

Resuscitation in acute upper GI bleed

Answer 4

• ABC, wide-bore IV access x2
  Platelet transfusion if actively bleeding platelet count of less than 50 X10*9/l
  Fresh frozen plasma to patients who have fibrinogen level of less than 1g/l or a PT time or APTT more than 1.5 X normal

Question 5

Endoscopy in upper GI bleed window

Answer 5

Offered immediately after resuscitation

All patients should have endoscopy within 24 hours

Question 6

Management of non- variceal bleeding

Answer 6

DO NOT give PPIs before endoscopy but give PPIs to patients with non-variceal upper GI bleed and stigmata of recent haemorrhage shown at endoscopy

Question 7

Management of variceal bleeding

Answer 7

Terlipressin and prophylactic antibiotics should be given to patients at presentation
Band-ligation should be used for oesophageal varices and injections of N-butyl-2-cyanoacrylate for patients with gastric varices

TIPPS - transjugular intrahepatic portosystemic shunts

Question 8

Acute treatment for variceal haemorrhage

Answer 8

ABC
Correct clotting FFP, vitamin K
Vasoactive agents: terlipressing
Ocreotide
Prophylactic antibiotics
Quinolones
Sengstaken-Blakemore tube if uncontrolled haemorrhage
TIPPS if above fails
Connects the HEPATIC vein to the PORTAL vein
Exacerbation of hepatic encephalopathy is common complication

Question 9

Prophylaxis of variceal haemorrhage

Answer 9

Propranolol- reduced rebleeding and mortality

Question 10

Differentiate between upper GI bleed vs lower GI bleed

Answer 10

High urea levels