Clinical aspects of an upper GI bleed Flashcards
How do upper GI bleeds present?
- Melaena
- Haematemesis
- Coffee-ground vomiting
What causes an upper GI bleed?
- Bleeding from:
- Stomach
- Duodenum
- Oesophagus
What are the top 3 causes of upper GI bleeding?
- Peptic ulcer
- Oesophagitis
- Gastritis
What are peptic ulcers caused by?
- Acid
- NSAIDs
- H. Pylori
Describe the management of an upper GI bleed?
- Resuscitate if required
- Endoscopic risk assessment
- Drug therapy and transfusion
What are the different levels of risk of GI bleed and how do you time endoscopy for each of them?
- Low risk
- Outpatient management
- Moderate risk
- Admit and next day endoscopy
- High risk
- Emergency endoscopy
How are severe upper GI bleeds identified?
- Age
- Pulse/BP
- Comorbidities
Name a endoscopic risk score for upper GI bleeds?
Rockall
Name some clinical scoring systems for upper GI bleeds?
- Admission Rockall
- Glasgow Blatchford
What is the purpose of the Rockall Scoring systems for upper GI bleeds?
Predict mortality
Name some endoscopic therapies for upper GI bleeding?
- Heater probe
- Endoscopic clips
- Thrombin, laser
- Adrenaline injection
Describe the use of IV PPIs in upper GI bleeds?
- Given post-endoscopy
- Only for higher risk patients
- Reduce bleeding and mortality
What are the next steps if someone taking Aspirin and NSAIDs has an upper GI bleed?
- Stop NSAIDs
- Continue low dose aspirin once haemostasis is achieved
What are the next steps if someone taking Copidogrel, Warfarin or DOACs has an upper GI bleed?
- Achieve haemostasis
- Discuss risks with patient and medical team
- Drugs are usually then restarted
Describe the use of blood products in upper GI bleeding?
- Give FFP if INR >1.5
- Tranfuse blood when Hb <7
- Tranfuse platelets if bleeding and platelets <50x109
- Give prothrombin complex concentrate if active bleeding on warfarin
How are varices treated?
- TIPS
- B-blockers
- Endoscopic banding
Why is the incidence of varices increasing?
- Rise in:
- Alcoholism
- Hep C infections
- Fatty liver disease
What causes varices?
- Increased portal pressure due to:
- Increased portal inflow
- Increased hepatic resistance
How can Acute variceal bleeding be diagnosed?
Endoscopy
Describe the resuscitation of Acute variceal bleeding?
- Tranfuse once Hb<7
- Restore circulatory volume
Describe the drug therapy for Acute variceal bleeding?
- Early antibiotics and vassopressors
- Endoscopic band ligation
Name a vasopressor?
Terlipressin
What does TIPS stand for?
Trans-jugular intrahepatic portal shunt
What can be done if variceal bleeding cannot be controlled?
- TIPS
- high mortality
- Sengstaken tube
What is given for primary prophylaxis of variceal bleeding?
Banding or beta blockers
What is the first line for oesophageal variceal bleeding?
Banding
What is given for acute gastric variceal bleeding?
Tissue glue injection
What is given for prevention of rebleeding of varices?
Beta blocker AND repeated banding
Describe the steps for optimal management of upper GI bleeding?
- Resuscitate
- Risk assess
- Timing of endoscopy
- Drug therapy and tranfusion