GI bleeding Flashcards
what is coffee ground vomiting?
occurs due to the presence of coagulated blood in the vomit.
what is the ROCKALL for GI bleeding?
ROCKALL score is based on bedside parameters that predicts the risk of death and rebleeding from an upper GI bleed. Higher score = higher chance of death from bleeding.
Includes age, co morbidities, shock, source of bleeding and stigmata of recent bleeding
what is the Blatchford score for GI bleeding?
predicts the need for intervention (blood transfusion or therapeutic endoscopy) and requires the results of blood tests in addition.
Useful in deciding if patient needs to be admitted.
markers include
- blood urea
- Hb
- systolic BP
- pulse
- melena
- syncope
- hepatic disease
- cardiac failure
How would you manage an upper GI bleed?
along with A-E approach, the following investigations
- FBC: to check Hb and platelet count (thrombocytopenia suggest chronic liver disease and platelets need replacing if low and bleeding)
- U&E: raised urea suggests upper GI bleed
- clotting: abnormal needs correcting to control bleed
- group and save: (cross match if haemaodynamically unstable )
- LFTs - normal LFTs doesn’t not exclude chronic liver disease
- Venous blood gas - get haemoglobin result
what is variceal bleeding and how does it present?
a medical emergency
most often presents with fresh haematemesis and/or melaena
how is variceal bleeding managed?
initial: gain IV access, fluid resuscitation if haemodynamically compromised (followed by blood). (Remember systolic BP is usually low in patients with cirrhosis)
Prescription: IV Terlipressin (if no IHD or PVD) and IV antibiotics
definitive treatment: refer urgently to GI team for Upper Gi endoscopy, for endoscopic banding of varcies. If this doesn’t work, a Linton or Sengstaken tube may be used as a temporary measure, or a TIPSS (trans-jugular intrahepatic porto-systemic shunt) procedure.
what are some causes of non vatical bleeding?
- vascular malformations e.g angiodysplasia (vascular malformations in gut) and dieulofoys
- ulcer disease
what is the management for non variceal bleeding?
initial : gain IV access, fluid resuscitation if haemodynamically compromised (followed by blood)
prescription: PPI may be indicated post endoscopy
definitive treatment: discuss with the gastroenterology team. If can’t stop bleeding by endoscopy, radiological embolization or surgery may be possible. Endoscopist will advise on the need for any treatment e.g PPI for ulcers after endoscopy.
