Upper GI Flashcards
what are the common causes of an upper GI bleed?
peptic ulcer disease in 35-50% gastrodudodenal erosions oesophagitis mallory-weiss tear varyx other: malignancy, AV malformation, swallowed blood (haemoptysis, facial trauma, epistaxis)
what are the clinical calculators applicable to upper GI management decisions?
Rockall (Pre-endoscopy/complete) Glasgow-Blatchford (better)
what is the Hb limit for transfusion in an upper GI bleed?
<70 g/L
if you suspect oesophageal varicies as the cause for an upper GI bleed, how does this change the management?
have to take liver failure into consideration (should already have LFTs ordered)
need to compensate for their clotting deficiency
give terlipressin IV 1-2 mg/6 hrs for <3 days
give tazocin IV 4.5 g/8 hours
what aspects of the history would make you consider oesophageal varicies?
history of liver failure or EtOH excess.
currently intoxicated or smells of alcohol
is endoscopy fails to control the bleeding, what are the second line treatment options for
1) oesophageal varyx
2) anything else
1 - Sengstaken-Blakemore tube sited by an senior
2- surgery or mesenteric angiography/embolisation
what is the role for PPI therapy in upper GI bleed?
none pre-endoscopy
give omeprazole 40 mg IV/PO OD following haemostasis
if underlying H pylori infection, treat with triple therapy
what is triple therapy for H pylori?
omeprazole 40 mg po bd
amoxicillin 1 g po bd
clarithromycin 500 mg/metronidazole 400 mg po bd
…check with local guidelines
what is the significance of a rebleed?
40% of patients who rebleed will die
if it occurs, do obs q15 mins and call for senior help
how do you test for H pylori?
13-C breath test or presence of stool antigen
what does the Blatchford score tell us?
what are some of the advantages of the Blatchford score over the Rockall score?
main purpose: to identify low-risk patients that can successfully be managed as an outpatient.. i.e. low Blatchford score is validated to support NOT ADMITTING
- can be used pre-endoscopy
- it does not count on a subjective assessment of the severity of systemic disease
