Upper GI bleed

Question 1

Give 4 causes of an upper GI bleed

Answer 1

• Oesophageal varices
• Mallory-Weiss tear
• Peptic ulcer
• Malignancy of the stomach/duodenum

Question 2

Describe the clinical features of an upper GI bleed

Answer 2

• Haematemesis (“coffee ground” vomit)
• Melaena
• Haemodynamic instability in severe bleeding (tachycardia, hypotension, shock)

Question 3

What is the name of the scoring tool used to assess the risk of an upper GI bleed?

Answer 3

Glasgow-Blatchford score

Question 4

What is the name of the scoring tool used to assess the risk of re-bleeding and mortality following an endoscopy for an upper GI bleed?

Answer 4

Rockall score

Question 5

Describe the management of a suspected upper GI bleed

If oesophageal varices are suspected, which additional steps are taken?

Answer 5

ABATED:

• ABCDE approach
• Bloods (FBC, U&E, LFTs, clotting, crossmatch)
• Access (IV)
• Transfuse
• Endoscopy (+/- interventions such as variceal banding or cauterisation of bleeding vessel)
• Drugs (stop anticoagulants and NSAIDs)

Oesophageal varices:

• Terlipressin (vasopressin analogue, which causes vasoconstriction)
• Prophylactic broad spectrum antibiotics

Question 6

What are oesophageal varices? Describe the pathophysiology.

Answer 6

Abnormal, enlarged veins in the oesophagus, caused by portal hypertension (usually as a result of liver cirrhosis)

Question 7

What is a Mallory-Weiss tear? Describe the pathophysiology

Answer 7

Tear in the mucous membrane of the lower oesophagus, usually caused by violent/repetitive vomiting

Question 8

Which emergency technique can be used to control bleeding in catastrophic upper GI haemorrhage secondary to suspected varices?

Answer 8

Sengstaken-Blakemore tube