Upper GI Bleed Flashcards
What are the key sources of upper GI bleeds? (4)
Peptic ulcer
Mallory-Weiss tear
Oesophageal varices
Stomach cancer
Bleeds associated with peptic ulcers have a history of what symptoms? (2)
Epigastric pain
Dyspepsia
What causes a Mallory-Weiss tear?
tend to occur after heavy retching or vomiting, which may be caused by binge drinking, gastroenteritis or hyperemesis gravidarum (in early pregnancy).
What are oesophageal varices associated with? (2)
Liver cirrhosis
Portal hypertension
What is stomach cancer associated with a history of? (5)
Weight loss
Epigastric pain
Treatment resistant dyspepsia
Anaemia
Raised platelet count
What is the Glasgow-blatchford bleeding score?
Estimates the risk of a patient having an upper GI bleed
What score estimates the risk of a patient having an upper GI bleed?
Glasgow-blatchford bleeding score
What is the rockall score?
Estimates the risk of bleeding and mortality after endoscopy
What score is used to estimate the risk of bleeding and mortality after an endoscopy?
Rockall score
What is the initial management of an upper GI bleed? (6)
• A – ABCDE approach to immediate resuscitation
• B – Bloods
• A – Access (ideally 2 x large bore cannula)
• T – Transfusions are required
• E – Endoscopy (within 24 hours)
• D – Drugs (stop anticoagulants and NSAIDs)
What bloods should be done in upper GI bleed management? (5)
○ Haemoglobin (FBC)
○ Urea (U&Es)
○ Coagulation (INR and FBC for platelets)
○ Liver disease (LFTs)
Crossmatch 2 units of blood
What transfusion is given to patients with massive upper GI bleeds?
Fresh frozen plasma
Blood, platelets and clotting factors
What transfusion is given to patient who take warfarin that are actively bleeding?
Prothrombin complex concentrate
What drugs are given to patients that have an upper GI bleed that you suspect is oesophageal varices? (2)
Terlipressin
Broad spectrum abx
What is the use of terlipressin in oesophageal varices?
acts as a vasoconstrictor reducing portal venous pressure and controls variceal bleading
Which type of abx are typically used in upper GI bleeds that are from oesophageal varices?
Broad spectrum typically quinolones
What is the definitive diagnosis and management of an upper GI bleed?
Ogd
What is done in an OGD for non-variceal bleeds to treat them? (2)
Clips
Thermal coagulation
How is an OGD used to treat oesophageal varices?
Variceal band ligation
When should PPIs be given to patients with non-variceal upper GI bleeding?
Not until after endoscopy
What is a Sengstaken-Blakemore tube and what is it used for?
has oesophageal and gastric balloons which can be inflated to tamponade the variceal bleeding. It is inserted through the nose. This is is the best management step during uncontrollable oesophageal bleed.
What is a transjugular intrahepatic portosystemic shunt and when is it used?
Connects hepatic vein to portal vein to stop variceal bleeding
If endoscopy and sengstaken-blakemore tube fail
What is used in the prophylaxis of variceal haemorrhage? (3)
• Propranolol
○ reduced rebleeding and mortality compared to placebo
• Endoscopic variceal band ligation (EVL)
○ superior to endoscopic sclerotherapy
○ it should be performed at two-weekly intervals until all varices have been eradicated
○ proton pump inhibitor cover is given to prevent EVL-induced ulceration
• Transjugular Intrahepatic Portosystemic Shunt (TIPSS) may be used if the above measures are unsuccessful in preventing further episodes
What is an easy test to distinguish between an upper and lower GI bleed?
Upper GI bleed has high levels of urea
This is from breakdown of blood
