Upper GI Bleed

Question 1

Risk Factors/causes

Answer 1

Peptic ulcer disease, mallory weiss tear, oesophageal varices.

Liver disease, alcohol, smoking, NSAID use.

Question 2

Symptoms and signs

Answer 2

Haematemesis/coffee ground vomit, malaena, dizziness, abdo pain, dysphagia.

Signs: lowered JVP and urine output.
Liver disease signs: telangiectasia, hepatomegaly, ascites, jaundice.

Question 3

Management/investigations (very complex)

Answer 3

A to E

Two grey cannula (IV access), bolus fluids, if lots the major haemorrhage protocol.

Investigations: Bloods - FBC, UandE, LFT, clotting, GandS, crossmatch 4-6 if major haemorrhage, CRP.
ABG

Prescribe - PPI, antiemetic, pabrinex, vasopressin (terlipressin) if varices.
Antibiotics guidelines.

Consider catheterise for fluid balance.

ARRANGE ENDOSCOPY