Upper GI Bleed Flashcards

1
Q

What are the main causes of UGI bleeds

A

Vascular
-esophageal varices

Iatrogenic/idiopathic
-NSAIDs, aspirin, anticoagulants, steroids => peptic ulcers

Trauma
-Mallory Weiss tear

Infective/inflammatory
-esophagitis, gastritis

Neoplastic
-malignancy

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2
Q

Types of peptic ulcer

  • causes
  • managemen
A

Gastric, duodenal (erosion of gastroduodenal artery causes heavy bleeding)

  • Hpylori - urea breath test/stool antigen => PPI + amoxicillin + clarythromycin + metronidazole
  • NSAIDs, smoking, alcohol, stress => PPI

Repeat OGD in 6-8wks due to risk of malignancy

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3
Q

Mallory Weiss tear

-presentation

A

Severe vomiting => Gastroesophageal junction bleed => hematemesis

  • no prior systemic upset or symptoms
  • self limiting
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4
Q

Gastric, esophageal malignancy

  • presentation
  • risk factors
A

Adenocarcinomas most common

Esophagus - GERD, Barrett’s esophagus, smoking, obesity
-Dysphagia, anorexia, weight loss
Vomiting, melena, hoarse voice

Stomach - HPylori, smoking, salt preserved food
-Abdo pain, indigestion, dysphagia
Weight loss, anorexia
N+V

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5
Q

What is esophagitis associated with?

What is gastritis associated with?

A

Esophagitis - GERD
-small volume of blood, self limiting

Gastritis - NSAIDs
-unlikely cause of bleeding

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6
Q

Management of all acute UGI bleeds

A

Resus - A-E

  • 2 wide bore IV cannula
  • Platelets U50 AND actively bleeding => platelet transfusion
  • Fibrinogen U1.5g or high PT/aPTT => FFP (can add CP if needed)
  • Warfarin users => prothrombin complex + VitK

Endoscopy
-immediately after severe bleed or within 24hrs

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7
Q

Management of non variceal hemorrhage

-acute - definitive

A

Definitive

-endoscopic clips, thermal coagulation/argon laser + PPIs

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8
Q

Management of variceal hemorrhage

  • acute - initial and definitive
  • prophylaxis
A

Initial

  • terlipressin
  • prophylactic IV ABx for liver cirrhosis - quinolones

Definitive
-endoscopic variceal band ligation or TIPSS

Prophylaxis

  • propanolol
  • endoscopic variceal band ligation every 2wks
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9
Q

Presentation of UGI bleeds

A

Hematemesis - bright red or coffee grounds
Melena - black tarry stools
High urea due to high protein content of blood
Features associated with particular diagnosis

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10
Q

Risk assessments of all UGI bleeds

A

Blatchford Score - assess for OP management
-Not 0 - IP management

Rockall Score - pre and post endoscopy score for adverse outcomes

  • U3 = good prognosis
  • 8+ = high mortality
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