GI Bleeding Flashcards
Causes
Oesophageal varices
•Mallory-Weiss tear, which is a tear of the oesophageal mucous membrane
•Ulcers of the stomach or duodenum
•Cancers of the stomach or duodenum
Presentation
Haematemesis (vomiting blood)
•“Coffee ground” vomit. This is caused by vomiting digested blood that looks like coffee grounds.
•Melaena, which is tar like, black, greasy and offensive stools caused by digested blood
•Haemodynamic instability occurs in large blood loss, causing a low blood pressure, tachycardia and other signs of shock. Bear in mind that young, fit patients may compensate well until they have lost a lot of blood.
The patient may have symptoms related to underlying pathology:
•Epigastric pain and dyspepsia in peptic ulcers
•Jaundice for ascites in liver disease with oesophageal varices
What is the Glasgow Blatchford score?
The Glasgow-Blatchford Score is used as a scoring system in suspected upper GI bleed on their initial presentation. It scores patient based on their clinical presentation. It establishes their risk of having an upper GI bleed to help you make a plan (for example whether to discharge them or not).
What score indicates a patient is high risk for a bleed?
A score > 0 indicates high risk for an upper GI bleed. It takes into account various features indicating an upper GI bleed:
What parameters are measured in Glasgow Blatchford Score?
Drop in Hb •Rise in urea •Blood pressure •Heart rate •Melaena •Syncope
Why does Urea rise?
The reason urea rises in upper GI bleeds is that the blood in the GI tract gets broken down by the acid and digestive enzymes. One of the breakdown products is urea and this urea is then absorbed in the intestines.
What is the Rockall score?
The Rockall Score is used for patients that have had an endoscopy to calculate their risk of rebleeding and overall mortality.
What parameters are measured?
Age
•Features of shock (e.g. tachycardia or hypotension)
•Co-morbidities
•Cause of bleeding (e.g. Mallory-Weiss tear or malignancy)
•Endoscopic stigmata of recent haemorrhage such as clots or visible bleeding vessels
Management
(ABATED)
•A – ABCDE approach to immediate resuscitation
•B – Bloods
•A – Access (ideally 2 large bore cannula)
•T – Transfuse
•E – Endoscopy (arrange urgent endoscopy within 24 hours)
•D – Drugs (stop anticoagulants and NSAIDs)
What bloods should be sent?
Haemoglobin (FBC) •Urea (U&Es) •Coagulation (INR, FBC for platelets) •Liver disease (LFTs) •Crossmatch 2 units of blood
Things to consider for transfusion
Transfuse blood, platelets and clotting factors (fresh frozen plasma) to patients with massive haemorrhage
•Transfusing more blood than necessary can be harmful
•Platelets should be given in active bleeding and thrombocytopenia (platelets < 50)
•Prothrombin complex concentrate can be given to patients taking warfarin that are actively bleeding
Additional steps in oesophageal varices
Terlipressin
•Prophylactic broad spectrum antibiotics
What is the definitive treatment?
The definitive treatment is oesophagogastroduodenoscopy (OGD) to provide interventions that stop the bleeding, for example banding of varices or cauterisation of the bleeding vessel.
