GI bleed Flashcards
history of GI bleeds
prev admissions with GI bleeds diagnosis of liver failure ops or treatment for liver failure anticoagulants, NSAIDs, alcohol allergies
severity scores for UGIB
glasgow blatchford score rockall score (risk of re-bleeding or death)
high glasgow blatchford (23)
bad
high risk of requiring intervention e.g. transfusion or endoscopy
high rockall score 7
bad
high risk of re bleed or death in UGIB
LGIB scoring
oakland score
oakland score
predict whether safe to discharge patient with LGIB
if vomiting or drowsy
recovery position
fluid resussication for non massive haemorrhage
initial fluid resus with crytaloid (0.9 sodium chloride)
fluid resus in massive harmorrhage
initial reus with blood products
if not available then resus with crystaloid (0.9 NACl)
initiate massive haem protcol by calling the blood bank
correct clotting abnormalities
consider tranexamic acid in trauma pages
antibiotics and terlipressin if suspect varices as source
UGIB:
if ongoing bleed, suspecyed variceal bleed, unstable episode requiring transfusion or lost >30% blood vol
urgent OGD once reuss
if not - admit and do OGD within 24hrs
referrals for UGB
Contact senior in your team
Contact critical care outreach team
Referral to gastroenterologists
Consider referral to Intensive Care Unit (ICU)
IMMEDIATE management of LGIB
emergency CT angiogram w embolization
colonoscopy
likely OGD to rule out UGIB
future management of GI bleeds
review by gastroenterologists regarding future management
