S09C78 - Upper GIB

Question 1

Defn of UGIB

Answer 1

=bleeding originiating proximal to the ligament of treitz

Question 2

UGIB: Causes

Answer 2

• PUD
• erosive gastritis and esophagitis
• esophageal and gastric varices (16% mortality)
• mallory -weiss tear

Question 3

UGIB: investigations

Answer 3

• type and screen
• CBC
• BUN, lytes, coags, liver fxn
• BUN:Cr ration >30 suggests UGIB
• ECG for high risk CAD pts - ischemia from decr oxygen delivery causes bleeding
• scope (endoscopy)

Question 4

UGIB: Tx

Answer 4

• fluid resusc
• transfuse if continued bleeding and failure to improve perfusion and vital signs after 2L of crystalloids
• replace coag factors (platelets, fibrinogen, FFP)
• endoscopy
• IR embolization
• PPI - 80mg pantoprazole bolus followed by infusion 8mg/h
• octreotide
• vasopressin for variceal bleed
• BB for variceal bleed
• treat h. pylori
• IV erythro (acceleartes gastric emptying) before endoscopy
• tamponade with blakemore or Linton tube

Question 5

UGIB : perform a glasgow-blatchford bleeding score

Answer 5

-score of 0 is very low risk (BUN13, SBP >110, HR

Question 6

UGIB: features predictive of poor outcomes

Answer 6

-hct