APPROACH TO UPPER GI BLEED

Question 1

Aetiology of upper GI Bleed 5

Answer 1

PUD
Mallory-Weiss tear
Stress gastritis
Dieulafoy lesion
Gastroesophageal varices

Question 2

Most common cause of upper GI Bleeding

Answer 2

Gastric and duodenal ulcers

Question 3

Initial Resuscitation in upper GI BLEED

Answer 3

ABC
2 large bore peripheral IV line, can consider large bore central venous cather
Urine output- transurethral catheter (foley’s catheter)
Resus to target Hb of 7mg/dL
Consider Sengstaken-Blakemore tube for control of immediately life-threatening upper GI bleeding secondary to oesophageal varices.

Question 4

Medical Mx in upper GI bleed

Answer 4

PPIs
Octreotide (reduces the severity of acute upper GI bleeding 2° to varices)
Propranolol ( Prophylaxis against initial variceal haemorrhage and prevents reccurent bleeding)

Question 5

Definitive management of upper GI bleeding

Answer 5

Endoscopy
Angioembolisation
Transjugular Intrahepatic Portosytemic Shunt (TIPS)
Surgical intervention

Question 6

Endoscopic intervention in upper GI bleeding

Answer 6

Adrenaline injection
Thrombin injection
Thermocoagulation for ulcers or dieulafoy lesions.

For variceal bleeding: banding, endoclips, sclerosants, thrombin injection

Question 7

TIPS
+ complications, when to consider?

Answer 7

Connects portal vein with hepatic vein
Reduces rate of rebleeding
Doesn’t improve overall survival , has an increased rate of encephalopathy
Complications: Shunt stenosis and thrombosis

Should be considered in pts with variceal bleeding 2° to portal hypertension only after medical and endoscopic therapy has failed