Upper GI Bleed Flashcards

1
Q

What does an upper GI bleed indicate?

A

A medical emergency indicating a bleed from the oesophagus, stomach or duodenum

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2
Q

Causes of upper GI bleed?

A

1) Oesophageal varices
2) Mallory-Weiss tear (tear of oesophageal mucous membrane)
3) ulcer - stomach or duodenum
4) cancer - stomach or duoedenum

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3
Q

Presentation of an upper GI bleed?

A

1) Haematemesis - vomiting blood
2) ‘coffee ground vomit’ - digested blood
3) Melaena - digested blood (black, greasy, offensive)
4) Haemodynamic instability (tachycardia, hypotensive)

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4
Q

Additional symptoms related to underlying pathology?

A
  • peptic ulcer –> epigastric pain, dyspepsia

- oesophageal varices –> jaundice, ascites

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5
Q

Scoring system for suspected upper GI bleed?

A

Glasgow-Blatchford Score - establishes risk of having an upper GI bleed at initial presentation

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6
Q

What score indicates high risk (Glasgow-Blatchford score)?

A

Anything over 0

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7
Q

What features does the Glasgow-Blatchford score consider?

A
  • Drop in Hb
  • Rise in urea (digested in GI tract, reabsorbed as urea0
  • BP, HR
  • Mealena
  • Syncope
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8
Q

What score is used in a patient who has already had an endoscopy?

A

Rockall Score - provides % risk of rebleed + mortality

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9
Q

Risk factors + clinical features considered in Rockall score?

A
  • Age
  • Features of shock (BP, HR)
  • Co-morbidities
  • Cause of bleed
  • Endoscopic stigmata or recent haemorrhage (clots, visible bleeding vessels)
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10
Q

Management of upper GI bleed?

A

ABATED!

  • ABCDE approach to resus
  • Bloods
  • Access (2 large bore cannulas)
  • Transfuse
  • Endoscopy (urgent, within 24hrs)
  • Drugs (stop anticoagulants, NSAIDs)
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11
Q

Bloods to arrange (5)?

A

1) Haemoglobin (FBC)
2) Urea (U&E’s)
3) Coagulation (INR, FBC for platelets)
4) Liver disease (LFTs)
5) Crossmatch 2 units of blood

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12
Q

Outline transfusions (based on presentation)?

A
  • Massive haemorrhage –> blood, platelets + FFP (clotting factors)
  • Active bleed + platelets <50 –> Platelets
  • Active bleed + on warfarin –> PT complex concentrate
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13
Q

Additional management if patient present with oesophageal varices?

A

1) Terlipressin

2) Prophylactic broad spectrum abx

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14
Q

Definitive management?

A

OGD - oesophagogastroduoedenoscopy

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15
Q

Would you use a PPI prior to endoscopy?

A

NICE recommends against the use

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16
Q

Management of Mallory-Weiss tear?

A

Usually resolves spontaneously

17
Q

What would you give to a patient presenting with oesophageal varices prior to endoscopy?

A

Terlipressin + prophylactic abx (piperacillin/tazobactam)

18
Q

How many points is a patient with Ischaemic Heart Disease get on the Rockall score?

A

2

19
Q

Secondary prophylaxis of oesophageal varices?

A

Propanolol

20
Q

When would you suspect Mallory-Weiss tear?

A

History of forceful wretching (bulimia vs. alcohol bringe)

21
Q

What do you expect Hb levels to do after an acute bleed and before fluid resus?

A

Unchanged from baseline - measures free Hb in blood so loss of whole blood will not change conc