Upper GI Bleed Flashcards
What are the main causes of UGI bleeds
Vascular
-esophageal varices
Iatrogenic/idiopathic
-NSAIDs, aspirin, anticoagulants, steroids => peptic ulcers
Trauma
-Mallory Weiss tear
Infective/inflammatory
-esophagitis, gastritis
Neoplastic
-malignancy
Types of peptic ulcer
- causes
- managemen
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
Mallory Weiss tear
-presentation
Severe vomiting => Gastroesophageal junction bleed => hematemesis
- no prior systemic upset or symptoms
- self limiting
Gastric, esophageal malignancy
- presentation
- risk factors
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
What is esophagitis associated with?
What is gastritis associated with?
Esophagitis - GERD
-small volume of blood, self limiting
Gastritis - NSAIDs
-unlikely cause of bleeding
Management of all acute UGI bleeds
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
Management of non variceal hemorrhage
-acute - definitive
Definitive
-endoscopic clips, thermal coagulation/argon laser + PPIs
Management of variceal hemorrhage
- acute - initial and definitive
- prophylaxis
Initial
- terlipressin
- prophylactic IV ABx for liver cirrhosis - quinolones
Definitive
-endoscopic variceal band ligation or TIPSS
Prophylaxis
- propanolol
- endoscopic variceal band ligation every 2wks
Presentation of UGI bleeds
Hematemesis - bright red or coffee grounds
Melena - black tarry stools
High urea due to high protein content of blood
Features associated with particular diagnosis
Risk assessments of all UGI bleeds
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