Management of acute upper GI haemorrhage Flashcards
What is haematemesis?
Thick, clotted bright red blood that is vomited
What is melaena?
Passes through small bowel, producing melaena (black, thick, sticky, semi liquid stool)
What is a mallory-weiss tear?
Distal oesophageal lining can tear in repeated vomiting
What type of canulla should be placed in the case of haemorrhage?
Large bore IV in each antitubercular fossa
How is the severity of the haemorrhage determined?
Systolic BP <100 mmHg Pulse >100.min Hb <100 g/l Age >60 Comorbid disease Postural drop in BP
Who presents differently to haemorrhage?
Young people compensate then crash hard
Diabetics have a poor autonomic response - don’t respond with tachycardia
Beta-blockers prevent reflex tacycardia
What is the purpose of the endoscopy?
Identify cause
Theraputic manoeuvres
Assess risk of rebleeding
What can endoscopy be used to treat?
Bleeding peptic ulcers
Variceal bleeding
What is the stigmata of recent haemorrhage?
Active bleeding, oozing, overlyling clot, visible vessel
How can chronic gastric uclers be treated?
Endoscopic treatment Acid suppression Interventional radiology Surgery H. Pylori eradication
How can peptic ulcers be treated endoscopically?
Injection of adrenaline causing vasoconstriction Heater probe coagulation Combinations Clips Haemospray
How can acid suppressino be achieved?
IV omperazole
When should varices be suspected in upper GI haemorrhage?
Known history of cirrhosis Chronic alcohol excess Chronic viral hepatitis infection Metabolic or autoimmune liver disease Intra-abdominal sepsis/surgery
What are the aims of management of uppper GI bleeding?
Resucitation Haemostasis Prevent complications of bleeding Prevent deterioration of liver function Prevent early re-bleeding
What should be considered when managing upper GI bleeding?
Coagulopathy (FFP/platelets/vit K) CVP monitoring Parenteral vitamins Antibiotics Unexpected pathology e.g. perforated D.U Hypoglycaemia Replace K+, Mg 2+ and PO42- Delirium tremens
