Gastrointestinal Haemmorhage

Question 1

What are the symptoms of GI bleeding?

Answer 1

Haematemesis- can be bright red or coffee ground
Malaena
Haematochezia
Abdominal pain
Haemodynamically unstable

Question 2

What are the signs of GI bleeding?

Answer 2

Underlying cause

Shock

Question 3

What are the specific symptoms/signs of chronic GI bleeding?

Answer 3

Iron deficient anaemia

Question 4

What are the common causes of GI bleeding?

Answer 4

Peptic ulceration (40%)
-associated epigastric pain and NSAID use 
Gastroduodenal erosions (15%)
-epigastric pain
Oesophagitis (15%)
-hx of GORD and can self resolve
Mallory-Weiss syndrome (15%)
-background of excessive vomiting 
Varices (10%)
-liver dysfunction and haemodynamic instability
Upper GI malignancy
-O= progressive dysphagia and weight loss
-G= dyspepsia and weight loss

Question 5

What is Mallory-Weiss syndrome?

Answer 5

Tears at gastro-oesophageal junction due to violent vomiting

Question 6

What is the initial management of a pt w/ GI haemorrhage?

Answer 6

A-E assessment and observations
Insertion of 2 large bore cannulas
Bloods
-FBC
-CRP
-U&Es- raised urea
-LFTs
-Coagulation
-Crossmatch 

If platelets <50 then transfuse platelets
If fibrinogen <1g/L or APTT/PT 1.5times normal then transfuse FFP
If on warfarin and bleeding then commence prothrombin complex concentrate and stop warfarin

Urgent endoscopy within 24hrs

• if thought due to varices then abx and terlipressin given before
• -band ligation completed
• if not then wait till endoscopy completed before consider PPI commencement

Question 7

What is the Glasgow-Blatchford score?

Answer 7

Scoring system including
   -SBP
   -pulse
   -Hb
   -blood urea level
   -melaena
   -syncope
   -hepatic/cardiac disease
Score >6 indicates mortality >50%

Score >0 indicates high risk of upper GI bleed and require admission

Question 8

What are the indications for definitive laparotomy/angiographic embolisation?

Answer 8

Bleeding recurring after endoscopy
Bleeding persistent despite endoscopic
Bleeding torrential/obscuring embolisation

Question 9

What is the Rockall score?

Answer 9

Screening tool that includes endoscopy findings
Can give an estimate of mortality and rebleeding in upper GI bleeds

Looks at

• age
• shock level
• co-morbdities
• cause of bleed
• endoscopic stigmata of GI haemorrhage