Upper GI bleed

Question 1

Key sauces of bleeding in upper GI bleed?

Answer 1

• Peptic ulcer (most common)
• Mallory-Weiss tear ( a tear of the oesophageal mucosa
• Oesophageal varices (secondary to portal hypertension in liver cirrhosis)
• Stomach cancer

Question 2

Presenting features of upper GI bleed?

Answer 2

• Haematemesis (vomiting blood)
• Coffee ground vomit (caused by vomiting digested blood)
• Melaena- blood in stools

Question 3

Peptic ulcers are associated with a history of?

Answer 3

• Epigastric pain
• Dyspepsia
• They may be taking NSAIDs

Question 4

When do Mallory-Weiss tears tend to occur?

Answer 4

After heavy retching or vomiting- may be caused y binge drinking, gastroenteritis or hypermesis gravidarum

Question 5

What are oesophageal varices associated with? What signs would patients have?

Answer 5

Associated with liver cirrhosis and portal hypertension

Signs:
* Ascites
* Jaundice
* Caput medusae

Question 6

Stomahc cancer associated systems?

Answer 6

• Weight loss
• Epigastric pain
• Treatment-resistant dyspepsia
• Low Haemoglobin
• Raised platelet count

Question 7

Glasgow- Blatchford Bleeding score?

Answer 7

Estimates the risk of a patient having an upper GI bleed
Score above 0= high risk of upper GI bleed

Urea rises in upper GI bleeding due to the digestive enzymes breaking down the blood- an association worth remembering

Question 8

Rockall score?

Answer 8

Used after endoscopy to estimate risk of rebleeding and mortality

Takes into account:
* Age
* Shock
* Co-morbidites
* Cause of bleeding
* Endoscopic findings of recent bleeding

Question 9

Initial management of upper GI bleeding?

Answer 9

A-ABCDE approach to immediate resuscitation
B-Bloods
A- Access (ideally 2x large bore cannula
T- Transfusions are required
E- Endoscopy (within 24 hours)
D- Drugs (stop anticoagulants and NSAIDs)

Question 10

What is done to diagnose and treat the source of upper GI bleeding?

Answer 10

OGD endoscopy

Question 11

If Oesophageal varices are suspected what are the additonal treatment steps?

Answer 11

Terlipressin
Broad spec antibiotics- ceftriaxone

Question 12

What should not be given before endoscopy in non-variceal uper GI bleed?

Answer 12

PPI

but can be given after endoscopy when diagnosis is confirmed

Question 13

In upper GI bleed all patients should have what within 24 hours?

Answer 13

Endoscopy

Question 14

Which artery is source of bleeding occuring as a complication of peptic ulcer disease?

Answer 14

Gastroduodenal artery

Question 15

Treatment for peptic ulcer bleed?

Answer 15

PPI e.g. omeprazole

Question 16

Anatomical definition of an upper GI bleed?

Answer 16

With an origin proximal to the ligament of Treitz (also known as the suspensory muscle of the duodenum)- found at the duodenal flexure

Question 17

What may be rasied in upper GI bleed due to protein in the blood?

Answer 17

Urea

Question 18

Glasgow-Blatchford score?

Answer 18

Assess whether patients can be discharged and managed as outpatients

Score of 0 = considered for discharge

Question 19

When should TIPS be offered?

Answer 19

Transjugular intrahepatic protosyetmic shunts- when bleeding from varices is not controlled