Management of Acute Upper GI Haemorrhage

Question 1

haematemesis

Answer 1

vomiting of blood

Question 2

melaena

Answer 2

passing of blood through the GI tract and out the rectum

Question 3

causes for upper GI bleeding

Answer 3

duodenal ulcer
gastric erosions
gastric ulcers
varices
...

Question 4

resuscitation

Answer 4

Airway
Breathing
Circulation

airway protection
oxygen
IV access
fluids

Question 5

100 rule

Answer 5

systolic BP <100 mmHg
pulse >100/min
Hb <100g/l
age >60
comorbid disease
postural drop in blood pressure

Question 6

endoscopy

Answer 6

identify cause
therapeutic manoeuvres
assess risk of rebleeding

Question 7

rockall risk scoring system

Answer 7

scoring out of 11

Question 8

bleeding peptic ulcers

Answer 8

active bleeding

Question 9

duodeal ucler

Answer 9

low risk ulcer

no blood

Question 10

stigmata of recent haemorrhage

Answer 10

active bleeding/oozing

overlying clot

visible vessel

Question 11

chronic gastric ulcer

Answer 11

rolled edges

irregular

Question 12

ulcer treatment

Answer 12

endoscopic treatment - high risk ulcers

acid suppression

surgery

H.pylori eradication - secondary prevention

Question 13

endoscopic treament of peptic ulcers

Answer 13

injection - dilute adrenaline solutions
heater probe coagulation
combinations clips
haemospray

achievement of homeostasis

Question 14

endoscopic treament of peptic ulcers

Answer 14

injection - dilute adrenaline solutions
heater probe coagulation
combinations clips
haemospray

achievement of homeostasis

Question 15

acute variceal bleeding

Answer 15

risk factors
portal pressure > 12mmHg
varices >25% oesophageal lumen
presence of red signs
degree of liver failure

mortality = 25-50%

Question 16

acute variceal bleeding - aims of management

Answer 16

resusication
haemostasis
prevent complications of bleeding
prevent deterioration of liver function
prevent early re-bleeding

Question 17

achievement of haemostasis

Answer 17

terlipressin (vasopressin analogue)
endoscopic vatical ligation (banding)
sclerotherapy
senstaken-blakemore balloon
TIPS