UGIB

Question 1

Three risk factors for UGIB?

Answer 1

  Previous bleeds 
  Dyspepsia, known ulcers 
  Liver disease or oesophageal varices 
  Dysphagia, wt. loss 
  Drugs and EtOH 
  Co-morbidities

Question 2

Three signs of UGIB?

Answer 2

Melaena
Shock syx: hypotension, tachy, reduced GCS, CRT>2sec
CLD signs

Question 3

Three differentials for UGIB?

Answer 3

Peptic ulcer disease
Gastritis
Mallory-weiss tear
Varices
Mallory weiss tear
Ca stomach/oesophagus

Question 4

Which scoring system is used in UGIB to predict re-bleeding and mortality?

Answer 4

Rockall score

Question 5

What are three components of the Rockall score?

Answer 5

age <60
tachycardia and 
hypotension (signs of shock)
comorbidities
diagnosis e.g. mallory weiss tear, malignancy

Question 6

What is the management of UGIB?

Answer 6

Resus: oxygen, 2 x 14G cannulae, IV fluids up to 1L, bloods

Blood transfusion

Question 7

Which blood investigations would you conduct in UGIB?

Answer 7

FBC, U+E (↑ urea), LFTs, clotting, x-match, ABG, glucose

Question 8

What is the initial management of variceal bleed?

Answer 8

terlipressin IV

Prophylactic abx

Question 9

How can variceal bleeding be managed endoscopically?

Answer 9

1. Banding, adrenaline
2. Balloon tamponade
3. TIPSS if bleeding can’t be managed endoscopically

Question 10

What is the Glasgow-Blatchford score?

Answer 10

helps identify which patients with upper GI bleeding (UGIB) may be safely discharged from the emergency room.

Question 11

What are three components of the Glasgow-Blatchford score?

Answer 11

Hb
Sys BP
Melaena
Hepatic disease
High HR
Cardiac failure

Question 12

What is the Hong Kong protocol?

Answer 12

In gastroduodenal ulcer, recommendation to administer PPI/omeprazole IV

Question 13

Difference between overt and occult bleeding?

Answer 13

overt= obvious bleeding (melaena, haematemesis) while occult can only be traced through analysis- fecal occult blood positivity

Question 14

What is the management of UGIB?

Answer 14

1. ABCDE resuscitation
2. Risk assess for endoscopy
3. Endoscopy
4. Drug therapy
5. Transfusion?

Question 15

In which three ways can upper gastrointestinal bleeding present?

Answer 15

1. Haematemesis 2. Coffee ground vomit 3. Melaena- dark sticky faeces, digestion of blood

Question 16

Why do you get raised urea in UGIB?

Answer 16

a raised urea may be seen due to the ‘protein meal’ of the blood