Upper Gastrointestinal Bleeding

Question 1

What is upper gastrointestinal bleeding?

Answer 1

It refers to bleeding proximal to the ligament of Treitz, usually involving the oesophagus, stomach or duodenum

Question 2

What are the four oesophageal causes of upper gastrointestinal bleeding?

Answer 2

Oesophageal Varices

Oesophagitis

Mallory Weiss Tear

Oesophageal Cancer

Question 3

How do oesophageal variceal patients present?

Answer 3

Alcoholism

Chronic liver disease features

Question 4

What is a Mallory Weiss tear?

Answer 4

It is defined as a tear of the oesophageal mucous membrane

Question 5

What are the four gastric causes of upper gastrointestinal bleeding?

Answer 5

Peptic Ulceration

Gastritis

Dieulafoy Lesion

Gastric cancer

Question 6

What is a duodenal cause of upper gastrointestinal bleeding?

Answer 6

Aorto-Enteric Fistula

Question 7

What are the two most common causes of upper gastrointestinal bleeding?

Answer 7

Oesophageal varices

Peptic ulceration

Question 8

What are the five clinical features associated with upper gastrointestinal bleeding?

Answer 8

Haematemesis

Melaena

Epigastric Pain

Hypotension

Tachycardia

Question 9

What are the two appearances of haematemesis?

Answer 9

Fresh red blood

Coffee grounds

Question 10

What is coffee ground haematemesis?

Answer 10

It is vomiting of digested blood

Question 11

What is melaena?

Answer 11

It is tar-like, black, greasy and offensive stools

It is caused by the passing of digested blood in stools

Question 12

What are the two scoring systems used in upper gastrointestinal bleeding?

Answer 12

Glasgow Blatchford Score

Rockall Score

Question 13

When is the Glasgow Blatchford score used?

Answer 13

It is the initial scoring system used to risk assess suspected upper gastrointestinal bleeding

Question 14

What is the function of the Glasgow Blatchford score?

Answer 14

It can be applied to determine a management plan

Question 15

What Glasgow Batchford score suggests individuals are at high risk and should be hospitalised for further investigation?

Answer 15

> 0

Question 16

What is the management option for individuals with a Blatchford score of 0?

Answer 16

Discharge with advice and outpatient follow up

Question 17

What are the eight criteria used in the Glasgow Blatchford score?

Answer 17

Urea (mmol/L)

Haemoglobin (g/L)

Systolic Blood Pressure (mmHg)

Heart Rate (bpm)

Melaena

Syncope

Hepatic Disease

Cardiac Failure

Question 18

Which blood test result indicates an upper gastrointestinal bleed rather than a lower gastrointestinal bleed?

Answer 18

Increased urea levels

Question 19

When is the Rockall score used?

Answer 19

It is the scoring system used to risk assess suspected upper gastrointestinal bleeding AFTER an endoscopy

Question 20

What is the function of the Rockall score?

Answer 20

It provides a percentage risk of rebleeding and mortality

Question 21

What are the five criteria of the Rockall score?

Answer 21

Age

Shock Features (Hypotension, Tachycardia)

Co-Morbidities

Bleeding Aetiology

Endoscopic Features

Question 22

What is the first line management option in upper gastrointestinal bleeding?

Answer 22

Resuscitation

Question 23

What are the five resuscitation steps in upper gastrointestinal bleeding?

Answer 23

ABCDE Approach

Wide-Bore Cannula Insertion x2

Blood Sampling

Blood Transfusion

Endoscopy

Question 24

What five blood tests should be conducted to investigate upper gastrointestinal bleeding?

Answer 24

Full Blood Count (Haemoglobin, Platelets)

Urea & Electrolytes (Urea)

Liver Function Tests

International Normalised Ratio

Group & Save

Question 25

What pneumonic can be used to remember the resuscitation steps of upper gastrointestinal bleeding?

Answer 25

ABATED ABCDE management Bloods Access Transfusion Endoscopy Drugs

Question 26

What is the change that occurs in haemoglobin levels with upper gastrointestinal bleeding?

Answer 26

Decrease

Question 27

What is the change that occurs in urea levels with upper gastrointestinal bleeding? Why?

Answer 27

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

Question 28

How soon after presentation of upper gastrointestinal bleeding should individuals receive an endoscopy?

Answer 28

Within 24 hours

Question 29

In which circumstance, is platelet transfusion recommended in upper gastrointestinal bleeding?

Answer 29

Platelets < 50 x 109/L

Question 30

In which circumstance, is fresh frozen plasma transfusion recommended in upper gastrointestinal bleeding?

Answer 30

Fibrinogen < 1g/L OR INR > x 1.5

Question 31

In which circumstance, is prothrombin complex concentrate transfusion recommended in upper gastrointestinal bleeding?

Answer 31

A warfarin patient who is actively bleeding

Question 32

How do we pharmacologically manage upper gastrointestinal bleeding?

Answer 32

We review medications and stop those that could precipitate bleeding

Question 33

Which four medications are stopped in upper gastrointestinal bleeding?

Answer 33

NSAIDs Anti-Coagulants Anti-Platelets Tranexamic Acid

Question 34

Is it recommended to administer PPIs before endoscopy?

Answer 34

No

Question 35

In cases where the upper gastrointestinal bleeding is related to oesophageal varices, what are the two pharmacological management options?

Answer 35

Terlipressin Prophylactic Broad Spectrum

Question 36

What is the mechanism of action of terlipressin?

Answer 36

It is a vasoconstrictor of splanchnic blood supply, which reduces blood flow to the portal vein and therefore portal hypertension

Question 37

In cases where the upper gastrointestinal bleeding is related to oesophageal varices, what are the two surgical management options?

Answer 37

Band Ligation Transjugular Intrahepatic Portosystemic Shunts (TIPS)