GI bleeding

Question 1

What are the common causes of upper GI bleeds?

Answer 1

Peptic ulcer disease (50%)
Mallory-Weiss tears
Oesophagitis/gastritis
Varices
Gastric cancer

Question 2

What are the common causes of lower GI bleeds?

Answer 2

Diverticulitis
Gastroenteritis
Inflammatory bowel disease
Colorectal cancer
Anal fissures
Haemorrhoids

Question 3

How do upper GI bleeds present?

Answer 3

Haematemesis, "coffee ground" vomit
Melaena 
Abdominal pain, heartburn
Acute abdomen 
Dizziness
Pallor
Collapse
SOB
Anorexia, weight loss
Symptoms may precede haematemesis or melaena

Question 4

What are the risk factors for development of upper GI bleed?

Answer 4

PMHx: previous bleeds, peptic ulcer disease, hepatitis B and C, cirrhosis
DHx: NSAIDs, aspirin, iron, anticoagulants
FHx: bleeding disorders, gastric cancer
SHx: alcohol excess

Question 5

What are the clinical features of an upper GI bleed?

Answer 5

Tachypnoea, hypotension, tachycardia

Stigmata of liver failure, signs of anaemia

Question 6

How should a suspected upper GI bleed be investigated?

Answer 6

FBC, U+Es, coag, G&S/crossmatch
Erect CXR
Endoscopy

Question 7

Which scoring systems can be used in the diagnosis of upper GI bleed?

Answer 7

Glasgow-Blatchford and Rockall

Question 8

What is the Glasgow-Blatchford scoring system?

Answer 8

Identifies patients who are “low-risk” and can be discharged and treated as an outpatient

Question 9

What is the Rockall score?

Answer 9

Pre-endoscopy: determines risk of mortality prior to endoscopy

Complete: determines severity of GI bleed after endoscopy and chance of mortality

Question 10

Describe the acute management of a patient with a suspected upper GI bleed.

Answer 10

ABCDE assessment
IV fluids
FBC, U+Es, crossmatch
Urinary catheter 
Erect CXR
ECG, ABG
Transfuse if Hb <70
Terlepressin and IV Abx if variceal bleed
Arrange urgent endoscopy