Management of Upper GI Bleeding Flashcards
What would be the initial emergency management of an upper GI bleed?
ABC, oxygen, IV access, fluids
What factors should be used to consider the severity of a GI bleed?
- Systolic BP < 100
- Pulse > 100
- Hb < 100
- Age > 60
- Comorbid disease
- Postural drop in BP
What tends to happen when young people have a GI bleed?
They will compensate and then crash hard
What people are important to bear in mind in terms of GI bleeds?
Diabetics and people on beta-blockers
After you resuscitate a patient with GI bleeding what should you do?
Facilitate an endoscopy
What should you do when performing an endoscopy on a patient with an acute GI bleed?
Identify cause, perform any possible therapeutic manoeuvres, assess risk of re-bleeding
What should you do if the patient is haemodynamically compromised or there is suspicion of a massive bleed?
Cannulate both arms
What other tests should you run with an acute GI bleed?
FBC, U+E, g + s test, coagulation
What are risk factors for variceal bleeding?
Portal pressure > 12mmHg, varices > 25% oesophageal lumen, presence of red signs, degree of liver failure
What complications can variceal bleeding be due to?
Liver failure and sepsis
Apart from a known history of cirrhosis with varices, what else would cause suspicion?
History of alcohol excess, chronic hepatitis infection, metabolic or autoimmune liver disease, sepsis
What is the first line of treatment for variceal bleeding?
Resuscitation, antibiotics, terlipressin, OGD, endoscopic variceal ligation
If after treatment, a variceal bleed stops, what should you do?
Propranolol and banding programme
What is the second line treatment for a variceal bleed if first line doesn’t work?
Endoscopic variceal ligation again and SB tube
If a variceal bleed continues after second line treatment what should you do?
Insert a shunt
