GI Haemorrhage Flashcards
What is an upper GI bleed?
Bleeding from the oesophagus, stomach or duodenum
What are the causes of an upper GI bleed?
Pepetic ulcer
Oesophageal varices
Mallory Weiss tear
Oesophageal or gastric malignancy
Angiodysplasia
What are features of an upper GI bleed?
Haematemesis
Melaena
Epigastric pain
Increased urea
What is a lower GI bleed?
Bleeding from the distal duodenum and beyond
What are the causes of a lower GI bleed?
Diverticular disease
Haemorrhoids
Ischaemic colitis
Angiodysplasia
Inflammatory bowel disease
Meckel’s diverticulum
What are the features of a lower GI bleed
Magneta stools
Normal urea
What investigations are used in GI bleeds?
Urea
- Increased if upper
- Normal if lower
Upper GI endoscopy within 24 hours if upper
Colposcopy if lower
When should an endoscopy be given in GI haemorrhage?
Immediately after resucitation in severe bleed
All patients should recieve one within 24 hours
What should be given to patients before an endoscopy?
Terlipressin and prophylactic antibiotics
How are GI bleeds managed?
ABCDE
Treat cause
IV fluids
Platelet transfusion if platelets less than 50x^9/l
FFP transfusion if fibrinogen less than 1g/l
Vasoconstrictors
Variceal band ligation
Give examples of vasoconstrictors
B Blockers
Terlipressin
What scoring system predicts the mortality/risk of GI haemorrhage?
Blatchford Score
- Use at first assessment
Rockall Score
- Use after endoscopy
What factors does the Blatchford score take into consideration?
Increased urea
Decreased heamoglobin
Hypotension
Tachycardia
Melaena
Syncope
Hepatic disease
Cardiac failure
What does a Blatchford score of 0 suggest?
Patient can be considered for early discharge with advice and outpatient follow up
