GI & Hepatology: Upper GI Bleed Flashcards
What is the typical history for a patient with a UGI bleed?
PMH = liver disease, peptic ulcers, malignancy, surgery
DH = NSAIDs, anti-pt, anti-coag, steroids
FH = malignancy, bleeding disorders
SH = smoking, alcohol, drugs
Outline the aetiology of a UGI bleed.
Oesophageal varices in a chronic alcoholic
Mallory–Weiss tear after an alcohol binge
Oesophagitis
Bleeding peptic ulcer
Upper GI malignancy
Arteriovenous malformations
What are the signs and symptoms of a UGI bleed?
Haematemesis
Haemoptysis
Melena
Anaemia
Dysphagia
Weight loss
Jaundice
How would you investigate a UGI bleed?
Check observations, perform abdominal and PR examination
FBC, U+Es, LFTs, clotting, CRP, bone profile and group + save (if bleeding is minimal) or x-match between two and four units (depending on severity)
eCXR = Free air under diaphragm indicates perforation
Urgent upper GIT endoscopy - OGD
CT abdomen/chest – For all patients with aortic grafts
Angiography may be needed if source of bleeding not found at endoscopy
How would you manage a UGI bleed?
A-E assessment = high flow O2, IV assess/fluids, BP, AVPU, glucose, signs of haemorrhage
Rockall score or the Blatchford score to stratify those with greatest need of urgent endoscopy
NMB for endoscopy/surgery
Advice on alcohol intake and referral to alcohol specialist team for patients suffering from alcoholism
Medication review to identify medications that could cause gastritis/ulcers such as NSAIDs, steroids, SSRIs and bisphosphonates
PPI cover for any patients on long-term NSAIDs/steroids
2-week referral for patients with suspected malignancy
Treat positive H. pylori patients with triple therapy regime
What are the complications of a UGI bleed?
Anaemia
Shock
Death
What are the common risk factors for GI bleeding?
NSAIDs
Large alcohol intake
H.pylori infection
GI malignancy
How can the severity of an upper GI bleed be assesed?
GLASGOW-BLATCHFORD SCORE = to assess the need for admision
ROCKALL = identifying pts at risk on an rebleeding/mortality - age, shock, co-morbidity, diagnosis, evidence of bleeding
Describe the pathophysiology of oesophageal varices
Liver disease = cirrhosis/clot = portal hypertension = oesophageal varices = prone to bleed
Describe the pathophysiology of peptic ulcer disease
H.pylori = convert urea to ammonia (alkali) = inflam response, increased gastric acid, histamine = damage to surface glycoproteins = down regulate bicarb = ulcers
NSAIDs = inhib prostaglandin synthesis = reduced blood flow = reduced secretion of glycoprotein, mucous, phospholipids by gastric ep cells = weakened gastric mucosa to acid = ulcers
