Gastro - Upper GI Bleed Flashcards
What are the key sources of UGI bleeds?
Peptic ulcer (most common)
Mallory-Weiss tear
Oesophageal varices
Stomach cancers
What is a Mallory-Weiss tear?
Tear of the oesophageal mucosa
How do UGI bleeds present?
Haematemesis
Coffee ground vomit
Melaena
What is haemodynamic instability associated with?
Significant blood loss
Low BP
Tachycardia
Younger, fitter patients may compensate well until they lose a lot of blood
What are Mallory-Weiss tears associated with?
Heavy retching or vomiting
Binge drinking
Gastroenteritis
Hyperemesis gravidarum
What is the Glasgow-Blatchford Bleeding score?
Used at initially presentation in suspected UGI bleed
Estimates risk of patient have UGI bleed
Score over 0 indicates high risk of UGI bleed
Why does urea rise in UGI bleeds?
Acids and digestive enzymes break down blood
One of the breakdown products is urea
Absorbed in intestines causing a rise in blood urea
What is a Rockall score used for?
After endoscopy estimates risk of rebleeding and mortality
How are UGI bleeds managed?
ABATED
A- ABCDE approach
B- Bloods
A- Access (2x large bore cannula)
T- Transfusions
E- Endoscopy within 24 hours
D- Drugs, stop anticoagulants and NSAIDs
What bloods should be sent for in UGI bleeds?
FBC
U&Es
INR
LFTS
Crossmatch for 2 units of blood (Group and Save)
What is transfusion based on?
Individual presentation
- Blood, platelets and clotting factors
- Transfusing more blood than needed can be harmful
- Platelets given in active bleeding + thrombocytopenia
- Prothrombin complex concentrate if patients taking warfarin actively bleeding
If oesophageal varices are suspected what should also be given?
Terlipressin
Broad spectrum antibiotics
