Upper GI bleed

Question 1

Causes of UGIB

Answer 1

Oesophageal varices
M-W tear
Peptic ulcers
Upper GI cancers

Question 2

Presentation of UGIB

Answer 2

Coffee ground vomiting
Haematemesis
Malaena
Haemodynamic instability in large blood loss (tachycardia, hypotension)

Epigastric pain and dyspepsia (in PUD)
Jaundice/ascites in liver disease with oesophageal varices

Question 3

What scores can be used in UGIB?

Answer 3

Glasgow-Blatchford score - establishes risk of upper GI bleed in suspected upper GI bleed

Rockall score - is used for patients that have had an endoscopy to calculate their risk of rebleeding and overall mortality.

Question 4

Management of UGIB

Answer 4

ABATED

A – ABCDE approach to immediate resuscitation
B – Bloods (FBC, U&Es, LFTs, coagulation inc INR, crossmatch 2 units)
A – Access (ideally 2 large bore cannula)
T – Transfuse
E – Endoscopy (arrange urgent endoscopy within 24 hours)
D – Drugs (stop anticoagulants and NSAIDs)

Varices - also give IV terlipressin and prophylactic IV broad spectrum antibiotics

DEFINITIVE TREATMENT IS THE ENDOSCOPY:

• Banding of varices
• Cautery of bleeding vessel

NICE recommends not to use PPI before endoscopy here

Question 5

Transfusion in UGIB

Answer 5

Transfuse blood, platelets and clotting factors (fresh frozen plasma) to patients with massive haemorrhage

Platelets should be given in active bleeding and thrombocytopenia (platelets < 50)

Prothrombin complex concentrate can be given to patients taking warfarin that are actively bleeding