Gastrointestinal Bleeding

Question 1

What are the important parts of investigation in Upper GI bleeding?

Answer 1

• Examination - look for signs of cause e.g. chronic liver disease, PR for melaena
• Bloods - G+S/Crossmatch, FBC, U+E (increased urea), LFTs (Varices risk), clotting (coagulopathy in liver disease), glucose
• Catheterise (monitor UO)
• CXR and AXR once stable for aspiration/obstruction
• ODG
• Regular observations

Question 2

What is the general A-E management of upper GI bleeding?

Answer 2

A-E
-IV fluid resuscitation - aim for SPB of 100
-In massive blood loss activate major haemorrhage protocol for blood, FFP and platelets
-Blood transfusion if HB <7g/L
Patient must be haemodynamically stable before endoscopy

Question 3

What is the specific treatment of Acute variceal bleeding?

Answer 3

Terlipressin - splanchnic vasoconstrictor - reduces portal blood flow
Prophylactic antibiotics
Endoscopy:
-Band ligation
-Sclerotherapy
Sengstaken-Blakemore tube

Question 4

What is the specific treatment of Acute variceal bleeding?

Answer 4

Terlipressin - splanchnic vasoconstrictor - reduces portal blood flow
Prophylactic antibiotics
Endoscopy:
-Band ligation
-Sclerotherapy
Sengstaken-Blakemore tube

Question 5

What is the treatment of a non-variceal bleed?

Answer 5

Endoscopic intervention:
-Adrenaline injection into peptic ulcer
Pharmacological:
-IV proton pump inhibitor