Gastro Flashcards
What are causes of Upper GI bleed
Most common: Peptic ulcer disease
oesphagus: Mallory Weiss tear, oesophagitis, oesophageal varices
Stomach: dieulafoy lesion, gastroduodenal erosions
what are the two biggest RF for peptic ulcer disease
alcohol
NSAID use
What is oesophagitis and what is its biggest RF?
inflammation of the oesophagus
RF: GORD
What is a dieulafoy lesion
Torturous arteriole in stomach wall
It erodes and bleeds
What are symptoms of a dieulafoy lesion
haematemesis
melaena
iron def anaemia
What is the anatomical landmark for Upper vs lower GI bleed?
Upper = before ligament of Trietz Lower = below
How do you manage an acute UGI bleed?
- Resus with fluids OR packed RBC, platelets, clotting factors)
- Risk assess with score (Blatchford score)
- Endoscopy
How do you manage a variceal bleed
Terlipressin IV + antibiotics IV
give to ALL variceal bleeds, even before endoscopy if suspected
How do you manage a gastric varices
Butyl cyanoacrylate injection via endoscopy
Second line is TIPS
How do you manage oesophageal varies
endoscopic band ligation
Second line is TIPS, definitive management
How d you manage a non-variceal bleed?
With endoscopic:
- mechanical clips +/- adrenaline
- thermal coagulation +/- adrenaline
- fibrin / thrombin + adrenaline
PPI AFTER endoscopy
what scores can you use to guide Upper GI bleed management
Blatchford score - pre endoscopy
Rockall score - post endoscopy
When do you use Blatchford score and what does it incìlude
Use it PRE ENDOSCOPY
Allows to stratify patients based on high / low risk categories
To determine which patients need ICU admission / urgent endoscopy
includes need Bloods (Urea, Hb), Obs (SBP, HR), Gender, Hx (melaena, syncope, hepatic disease)
When do you use Rockall score and what does that include
Post-endoscopy score, used to guide prognosis
includes clinical bleeding and endoscopy results
When do you need. to do endoscopy for acute GI bleed
ENDOSCOPY immediately after resus if still acutely unwell / unstable
All else <24 hours
Explain what you would do for C (of A>E) in UGI bleed
Assessment and obs as usual
Interventions:
- 2 large bore cannulas
- urgent bloods: FBC, CRP, U/E, LFT, glucose, clotting, crossmatch 4-6 units
- catheterise and monitor UO
Resus:
- fluid bolus / blood
How do you chose whether to give fluid bolus or blood for resus in UGI bleed
Always give rapid IV crystalloid infusion immediatley (as more widely accessible, available immediately) - give up to 2L
Give blood in accordance to local protocol, generally if:
- Hb <70
- Signs of grade 3/4 shock
What blood do you give if required in UGI bleed?
- packed RBC (O-ve if crossmatch not yet available)
- consider giving platelets (if also low platelets) and clotting factors (PCC if on warfarin, FFP if PT/APTT >1.5x normal)
What do you do if patient with UGI bleed is on aspirin or NSAID
STOP the NSAID
continue low dose aspirin if for secondary prevention and haemostasis has been achieved
