Upper Gastrointestinal Bleeding Flashcards
What is the term used to describe vomiting of blood?
Haematemesis
What type of stool indicates an Upper GI bleed?
Black tarry stool- Melaena
List 8 common causes of Upper GI Bleed
- Oesophageal varices
- Mallory-Weiss Tear
- Peptic Ulcers
- Malignancy
- Drugs
- Gastritis
- Oesophagitis
- Duodenitis
What are oesophageal varices?
Submucosal venous dilatation secondary to inc. portal pressures
What is a Mallory-Weiss Tear
A Mallory-Weiss tear is a tear of the tissue of your lower esophagus. It is most often caused by violent coughing or vomiting.
What is gastritis?
Inflammation of the lining of the stomach
Which drugs can cause upper GI bleeds?
NSAIDS Aspirin Thrombolytics Anticoagulants Steroids
What should you ask about in the medical history of a patient who has upper Gi bleed?
- Previous GI Bleed
- Dyspepsia/ known ulcers
- known Liver Disease or Oesophageal Varices
- Vomiting
- Weight Loss
- Drug use
- Alcohol use
List some signs of Upper GI bleed
- Signs of Chronic Liver Disease
- Cool and clammy peripheries
- Inc. capillary refilling time
- Tachycardia (>100bpm JVP not raised)
- Systolic BP <100mmHg
Which score can be done to assess Risk Stratification in Acute GI Bleed?
Modified Blatchford Score
A Blatchford score of less than what value is associated with good prognosis for Gi Bleed
2 or less
Which markers are used in the modified Blatchford score to asses risk stratification in acute GI bleed?
Male/Female HB Blood Urea /c melena /c Syncope Tachycardia Hepatic Disease Cardiac Failure
What are the 9 steps to managing Upper GI Bleed?
- IV Access
- Clinical assessment
- Basic Investigations
- Resuscitation
- Oxygen (if pt in shock)
- Endoscopy
- Monitoring
- Surgery (if endoscopic haemostasis fails)
- Eradication (for H.Pylori inf.)
Intravenous access is the 1st step to managing and treating GI Bleeds, explain what is done
- site 2 large bore cannulas
Initial Clinical Assessment is the 2nd step in managing pts with acute upper GI Bleed, explain what is done
- Define circulatory status
- Seek Evidence of liver disease
- Identify Comorbidity
Why is it important to identify co-morbidity in the clinical assessment of acute Upper GI Bleed?
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
List 5 basic investigations done when managing a pt with acute upper GI Bleed
- CBC
- U&E
- prothrombin time
- LFTs
- Group and cross-match
what will you see in a CBC of a pt with an acute gi bleed
Chronic or subacute bleeding leads to
anaemia but the haemoglobin concentration may be
normal after sudden, major bleeding until haemodilution
occurs.
What might you find in relation to UandEs that can indicate severe GI bleed
an
elevated blood urea with normal creatinine concentration
implies severe bleeding.
What is the significance of finding prothrombin time in pts with acute GI bleed
Check for clinical evidence of chronic liver disease or if the patient is anticoagulated
what are some methods of endoscopic hemostasis
- cauterization
- endoscopic clips
- dilute adrenaline (epinephrine)
Methods of endoscopic stasis coupled with what drug therapy can reduce the risk of re bleeding
PPI
- esomeprazole
- omeprazole
- pantoprazole
- lansoprazole
What is the management of Gi bleeds sec. to oesophageal varices?
Endoscopic banding (oesophageal)
Sclerotherpy (gastric)
