Upper GI bleed Flashcards
Where does bleeding come from in an upper GI bleed?
oesophagus
stomach
duodenum
What are the causes of an upper GI bleed?
mallory weiss tear
oesophageal varices
stomach or duodenal ulcer
stomach or duodenal cancer
what is a mallory Weiss tear?
tear of the oesophageal mucous membrane from persistent vomiting
What causes oesophageal varies?
chronic liver disease
What is the presentation of an upper GI bleed?
haematemesis coffee ground vomit malaena haemodynamic instability (Low BP, tachycardia) epigastric pain - in ulcers weight loss - in cancer jaundice or ascites - in liver disease
what is the Glasgow blatchford score used for?
to determine timings of endoscopy > 0 = high risk heart rate blood pressure syncope rise in blood urea level malaena drop in haemoglobin
What does a rise in blood urea show?
when blood is released into the stomach its broken down into urea which is taken up by the blood - slows blood released into GI tract
What is the rockall score for?
for patients who have had an endoscopy to determine the likeliness of re-bleeding.
What is the management of an upper GI bleed?
Transfuse - Blood with or without platelets and frozen plasma
IV fluid resuscitation
Access - 2 large bore cannulas
Endoscopy - diagnosis + banding varices
what is the investigation done?
endoscopy OGD (within 24hrs)
stop all anticoagulants and NISADS before
Blood tests - all
what should be given in active bleeding?
platelets
what is advised against but many doctors give for management?
PPI
what is given to bleeding patients on warfarin?
prothrombin complex concentration
How are oesophageal caries treated?
Terlipessin - constricts blood vessels
Prophylactic broad spectrum antibiotics
Endoscopy - OGD - banding varices
