Upper GI Bleed Flashcards
What does an upper GI bleed indicate?
A medical emergency indicating a bleed from the oesophagus, stomach or duodenum
Causes of upper GI bleed?
1) Oesophageal varices
2) Mallory-Weiss tear (tear of oesophageal mucous membrane)
3) ulcer - stomach or duodenum
4) cancer - stomach or duoedenum
Presentation of an upper GI bleed?
1) Haematemesis - vomiting blood
2) ‘coffee ground vomit’ - digested blood
3) Melaena - digested blood (black, greasy, offensive)
4) Haemodynamic instability (tachycardia, hypotensive)
Additional symptoms related to underlying pathology?
- peptic ulcer –> epigastric pain, dyspepsia
- oesophageal varices –> jaundice, ascites
Scoring system for suspected upper GI bleed?
Glasgow-Blatchford Score - establishes risk of having an upper GI bleed at initial presentation
What score indicates high risk (Glasgow-Blatchford score)?
Anything over 0
What features does the Glasgow-Blatchford score consider?
- Drop in Hb
- Rise in urea (digested in GI tract, reabsorbed as urea0
- BP, HR
- Mealena
- Syncope
What score is used in a patient who has already had an endoscopy?
Rockall Score - provides % risk of rebleed + mortality
Risk factors + clinical features considered in Rockall score?
- Age
- Features of shock (BP, HR)
- Co-morbidities
- Cause of bleed
- Endoscopic stigmata or recent haemorrhage (clots, visible bleeding vessels)
Management of upper GI bleed?
ABATED!
- ABCDE approach to resus
- Bloods
- Access (2 large bore cannulas)
- Transfuse
- Endoscopy (urgent, within 24hrs)
- Drugs (stop anticoagulants, NSAIDs)
Bloods to arrange (5)?
1) Haemoglobin (FBC)
2) Urea (U&E’s)
3) Coagulation (INR, FBC for platelets)
4) Liver disease (LFTs)
5) Crossmatch 2 units of blood
Outline transfusions (based on presentation)?
- Massive haemorrhage –> blood, platelets + FFP (clotting factors)
- Active bleed + platelets <50 –> Platelets
- Active bleed + on warfarin –> PT complex concentrate
Additional management if patient present with oesophageal varices?
1) Terlipressin
2) Prophylactic broad spectrum abx
Definitive management?
OGD - oesophagogastroduoedenoscopy
Would you use a PPI prior to endoscopy?
NICE recommends against the use