Upper Gastrointestinal Bleeding

Question 1

What is the term used to describe vomiting of blood?

Answer 1

Haematemesis

Question 2

What type of stool indicates an Upper GI bleed?

Answer 2

Black tarry stool- Melaena

Question 3

List 8 common causes of Upper GI Bleed

Answer 3

• Oesophageal varices
• Mallory-Weiss Tear
• Peptic Ulcers
• Malignancy
• Drugs
• Gastritis
• Oesophagitis
• Duodenitis

Question 4

What are oesophageal varices?

Answer 4

Submucosal venous dilatation secondary to inc. portal pressures

Question 5

What is a Mallory-Weiss Tear

Answer 5

A Mallory-Weiss tear is a tear of the tissue of your lower esophagus. It is most often caused by violent coughing or vomiting.

Question 6

What is gastritis?

Answer 6

Inflammation of the lining of the stomach

Question 7

Which drugs can cause upper GI bleeds?

Answer 7

NSAIDS
Aspirin
Thrombolytics
Anticoagulants
Steroids

Question 8

What should you ask about in the medical history of a patient who has upper Gi bleed?

Answer 8

• Previous GI Bleed
• Dyspepsia/ known ulcers
• known Liver Disease or Oesophageal Varices
• Vomiting
• Weight Loss
• Drug use
• Alcohol use

Question 9

List some signs of Upper GI bleed

Answer 9

• Signs of Chronic Liver Disease
• Cool and clammy peripheries
• Inc. capillary refilling time
• Tachycardia (>100bpm JVP not raised)
• Systolic BP <100mmHg

Question 10

Which score can be done to assess Risk Stratification in Acute GI Bleed?

Answer 10

Modified Blatchford Score

Question 11

A Blatchford score of less than what value is associated with good prognosis for Gi Bleed

Answer 11

2 or less

Question 12

Which markers are used in the modified Blatchford score to asses risk stratification in acute GI bleed?

Answer 12

Male/Female HB
Blood Urea
/c melena
/c Syncope 
Tachycardia
Hepatic Disease
Cardiac Failure

Question 13

What are the 9 steps to managing Upper GI Bleed?

Answer 13

• IV Access
• Clinical assessment
• Basic Investigations
• Resuscitation
• Oxygen (if pt in shock)
• Endoscopy
• Monitoring
• Surgery (if endoscopic haemostasis fails)
• Eradication (for H.Pylori inf.)

Question 14

Intravenous access is the 1st step to managing and treating GI Bleeds, explain what is done

Answer 14

• site 2 large bore cannulas

Question 15

Initial Clinical Assessment is the 2nd step in managing pts with acute upper GI Bleed, explain what is done

Answer 15

• Define circulatory status
• Seek Evidence of liver disease
• Identify Comorbidity

Question 16

Why is it important to identify co-morbidity in the clinical assessment of acute Upper GI Bleed?

Answer 16

The presence of cardiorespiratory, cerebrovascular and renal diseases are important because

• they may be worsened by acute bleeding
• increase hazards of endoscopy and surgical operations

Question 17

List 5 basic investigations done when managing a pt with acute upper GI Bleed

Answer 17

• CBC
• U&E
• prothrombin time
• LFTs
• Group and cross-match

Question 18

what will you see in a CBC of a pt with an acute gi bleed

Answer 18

Chronic or subacute bleeding leads to
anaemia but the haemoglobin concentration may be
normal after sudden, major bleeding until haemodilution
occurs.

Question 19

What might you find in relation to UandEs that can indicate severe GI bleed

Answer 19

an
elevated blood urea with normal creatinine concentration
implies severe bleeding.

Question 20

What is the significance of finding prothrombin time in pts with acute GI bleed

Answer 20

Check for clinical evidence of chronic liver disease or if the patient is anticoagulated

Question 21

what are some methods of endoscopic hemostasis

Answer 21

• cauterization
• endoscopic clips
• dilute adrenaline (epinephrine)

Question 22

Methods of endoscopic stasis coupled with what drug therapy can reduce the risk of re bleeding

Answer 22

PPI

• esomeprazole
• omeprazole
• pantoprazole
• lansoprazole

Question 23

What is the management of Gi bleeds sec. to oesophageal varices?

Answer 23

Endoscopic banding (oesophageal)

Sclerotherpy (gastric)