Upper GI Bleed

Question 1

Causes of upper GI bleeds?

Answer 1

oesophageal varices, mallory weiss tear, ulcers and cancers

Question 2

presentation of upper GI bleed?

Answer 2

haematemesis
coffe ground vomit
melaena
haemodynamic instability: hypotension, tachycardia
possible epigastric pain, dyspepsia
jaundice or ascites

Question 3

which score to used in suspected upper GI bleed?

Answer 3

glasgow- blatchford

Question 4

which score to used in suspected upper GI bleed?

Answer 4

glasgow- blatchford

Question 5

what does a glagow blatchford score contain?

Answer 5

drop in hb
rise in urea
blood pressure
heart rate
melaena
syncopy

Question 6

what score to use to assess risk of rebleeding after patient has had endoscopy?

Answer 6

rockall score

Question 7

what does the rockall score take into account?

Answer 7

comorbidities
age
features of shock
cause of bleeding
endoscopic stigamata

Question 8

management of upper GI bleeds?

Answer 8

ABATED
ABCDE
Bloods
Access
Transfuse
Endoscopy (24 hours)
Drugs (stop anticoagulants/ NSAIDs)

Question 9

if patient has massive haemorrhage what do you transfuse?

Answer 9

blood, platelets, clotting factors (fresh frozen plasma)

Question 10

when should platelets be given?

Answer 10

active bleeding, thrombocytopenia <50

Question 11

what do you give a patient who is on warfarin and is bleeding?

Answer 11

prothrombin complex concentrate

Question 12

if varices are suspected what should you give?

Answer 12

terlipressin, broad spectrum antibiotics