Upper Gastrointestinal Bleeding Flashcards
What is upper gastrointestinal bleeding?
It refers to bleeding proximal to the ligament of Treitz, usually involving the oesophagus, stomach or duodenum
What are the four oesophageal causes of upper gastrointestinal bleeding?
Oesophageal Varices
Oesophagitis
Mallory Weiss Tear
Oesophageal Cancer
How do oesophageal variceal patients present?
Alcoholism
Chronic liver disease features
What is a Mallory Weiss tear?
It is defined as a tear of the oesophageal mucous membrane
What are the four gastric causes of upper gastrointestinal bleeding?
Peptic Ulceration
Gastritis
Dieulafoy Lesion
Gastric cancer
What is a duodenal cause of upper gastrointestinal bleeding?
Aorto-Enteric Fistula
What are the two most common causes of upper gastrointestinal bleeding?
Oesophageal varices
Peptic ulceration
What are the five clinical features associated with upper gastrointestinal bleeding?
Haematemesis
Melaena
Epigastric Pain
Hypotension
Tachycardia
What are the two appearances of haematemesis?
Fresh red blood
Coffee grounds
What is coffee ground haematemesis?
It is vomiting of digested blood
What is melaena?
It is tar-like, black, greasy and offensive stools
It is caused by the passing of digested blood in stools
What are the two scoring systems used in upper gastrointestinal bleeding?
Glasgow Blatchford Score
Rockall Score
When is the Glasgow Blatchford score used?
It is the initial scoring system used to risk assess suspected upper gastrointestinal bleeding
What is the function of the Glasgow Blatchford score?
It can be applied to determine a management plan
What Glasgow Batchford score suggests individuals are at high risk and should be hospitalised for further investigation?
> 0
What is the management option for individuals with a Blatchford score of 0?
Discharge with advice and outpatient follow up
What are the eight criteria used in the Glasgow Blatchford score?
Urea (mmol/L)
Haemoglobin (g/L)
Systolic Blood Pressure (mmHg)
Heart Rate (bpm)
Melaena
Syncope
Hepatic Disease
Cardiac Failure
Which blood test result indicates an upper gastrointestinal bleed rather than a lower gastrointestinal bleed?
Increased urea levels
When is the Rockall score used?
It is the scoring system used to risk assess suspected upper gastrointestinal bleeding AFTER an endoscopy
What is the function of the Rockall score?
It provides a percentage risk of rebleeding and mortality
What are the five criteria of the Rockall score?
Age
Shock Features (Hypotension, Tachycardia)
Co-Morbidities
Bleeding Aetiology
Endoscopic Features
What is the first line management option in upper gastrointestinal bleeding?
Resuscitation
What are the five resuscitation steps in upper gastrointestinal bleeding?
ABCDE Approach
Wide-Bore Cannula Insertion x2
Blood Sampling
Blood Transfusion
Endoscopy
What five blood tests should be conducted to investigate upper gastrointestinal bleeding?
Full Blood Count (Haemoglobin, Platelets)
Urea & Electrolytes (Urea)
Liver Function Tests
International Normalised Ratio
Group & Save
What pneumonic can be used to remember the resuscitation steps of upper gastrointestinal bleeding?
ABATED
ABCDE management
Bloods
Access
Transfusion
Endoscopy
Drugs
What is the change that occurs in haemoglobin levels with upper gastrointestinal bleeding?
Decrease
What is the change that occurs in urea levels with upper gastrointestinal bleeding? Why?
Increase
The blood in the gastrointestinal tract is broken down by digestive enzymes
Urea is one of the breakdown products and is then absorbed in the intestines
How soon after presentation of upper gastrointestinal bleeding should individuals receive an endoscopy?
Within 24 hours
In which circumstance, is platelet transfusion recommended in upper gastrointestinal bleeding?
Platelets < 50 x 109/L
In which circumstance, is fresh frozen plasma transfusion recommended in upper gastrointestinal bleeding?
Fibrinogen < 1g/L
OR
INR > x 1.5
In which circumstance, is prothrombin complex concentrate transfusion recommended in upper gastrointestinal bleeding?
A warfarin patient who is actively bleeding
How do we pharmacologically manage upper gastrointestinal bleeding?
We review medications and stop those that could precipitate bleeding
Which four medications are stopped in upper gastrointestinal bleeding?
NSAIDs
Anti-Coagulants
Anti-Platelets
Tranexamic Acid
Is it recommended to administer PPIs before endoscopy?
No
In cases where the upper gastrointestinal bleeding is related to oesophageal varices, what are the two pharmacological management options?
Terlipressin
Prophylactic Broad Spectrum
What is the mechanism of action of terlipressin?
It is a vasoconstrictor of splanchnic blood supply, which reduces blood flow to the portal vein and therefore portal hypertension
In cases where the upper gastrointestinal bleeding is related to oesophageal varices, what are the two surgical management options?
Band Ligation
Transjugular Intrahepatic Portosystemic Shunts (TIPS)
