GI Haemorrhage Risk Stratification and Management

Question 1

What scores are used for Risk Strat of UGIH

Answer 1

Rockall - predicts death and rebleed risk

Blatchford - decides who needs endoscopy

Question 2

What does the Rockall Score factor in

Answer 2

Age
Shock 
Comorbidity 
Diagnosis
Major Stigmata of Recent Haemorrhage

Question 3

What does the Blatchford Score measure

Answer 3

Blood urea
Haemoglobin 
Systolic BP
Pulse rate 
Cardiac and liver disease

Question 4

Which factors are considered in a LGIH risk stratification

Answer 4

Age
Comorbidity 
Inpatient
Initial Shock 
Drugs

Question 5

What is Shock

Answer 5

Circulatory collapse which results in inadequate oxygen being delivered to tissues causing hypoperfusion

Question 6

How is shock classified

Answer 6

Stage 1-4 based on:

Resp rate - increases
Heart rate - increases
Lost blood volume - increases
BP - decreases
Pulse pressure - decreases
Conscious level - anxious - agitated - confused - drowsy
Urine Output - decreases

Question 7

Management of Major Bleeding

Answer 7

Resus - ABC (IV access, Blood samples) DE
Blood transfusion (if Hb <7g/dl)
Risk Strat for HDU placement
Endoscopy once stable
Withhold or reverse contributory meds (vit k if warfarin)
Consider CT angiography or surgery

Question 8

Peptic Ulcer Bleeding Management

Answer 8

PPI’s
Endoscopy with endotherapy (adrenaline infection with thermal or clips works best)

If bleeding is uncontrolled on endoscopy:

Angiography with embolisation
Laparoscopy

Question 9

Varices Therapy

Answer 9

Intubation for airway protection

Endoscopy - Glue injection or band ligation (only for oesophageal)

IV terlipressin - vasoconstrictor which reduces portal pressure by restricting blood flow to portal vein

IV broad spectrum antibiotics

Coagulopathy

Question 10

What would you use for treating varices if bleeding was still uncontrolled after endoscopy

Answer 10

Sengstaken-blakemore tube - as a transjugular intrahepatic porto-systemic shunt