Upper GI Bleed

Question 1

Upper GI Bleed

Answer 1

medical emergency

Question 2

causes

Answer 2

Mallory-Weis tear - constant vomiting
perforated ulcer - gastric or duodenal 
maligancy
variceal bleed - portal hypertension
gastric cancer

Question 3

signs

Answer 3

haemestesis
melaena
coffee ground vomiting

Question 4

investigations

Answer 4

GBS score - assesses how to manage patient and when to do endoscopy

give IV fluids if needed
endoscopy - locate site of bleeding
CT if not able to see anything during endoscopy

Rockall score - post-endoscopy score to assess mortality

Question 5

management

Answer 5

ABCDE approach

resuscitate:
IV fluids usually by 2 cannulas
blood transfusion if Hb<7 +/- plasma, co-agulation factors
prothrombin complex concentration - patients on warfarin

endoscopy should be offered within 24hrs after resuscitation

non-variceal bleeding:
endoscopy
radiological intervention

variceal bleeding:
terlipressin and antibiotics before endoscopy 
band ligation - oesophageal
injections - gastric 
shunting if above measures dont work

Question 6

what will be seen in bloods during a upper GI bleed

Answer 6

high urea

Question 7

is a Hb test useful in this scenario

Answer 7

no because it will remain at baseline

Question 8

what anatomical landmark will the haemorrhage be seen on the endoscopy

Answer 8

ligament of treitz

Question 9

what should be given before an endoscopy is done

Answer 9

antibiotics

Question 10

when do you give PPO

Answer 10

post-endoscopy