Upper GI Bleed

Question 1

What are the key sources of upper GI bleeds? (4)

Answer 1

Peptic ulcer
Mallory-Weiss tear
Oesophageal varices
Stomach cancer

Question 2

Bleeds associated with peptic ulcers have a history of what symptoms? (2)

Answer 2

Epigastric pain
Dyspepsia

Question 3

What causes a Mallory-Weiss tear?

Answer 3

tend to occur after heavy retching or vomiting, which may be caused by binge drinking, gastroenteritis or hyperemesis gravidarum (in early pregnancy).

Question 4

What are oesophageal varices associated with? (2)

Answer 4

Liver cirrhosis
Portal hypertension

Question 5

What is stomach cancer associated with a history of? (5)

Answer 5

Weight loss
Epigastric pain
Treatment resistant dyspepsia
Anaemia
Raised platelet count

Question 6

What is the Glasgow-blatchford bleeding score?

Answer 6

Estimates the risk of a patient having an upper GI bleed

Question 7

What score estimates the risk of a patient having an upper GI bleed?

Answer 7

Glasgow-blatchford bleeding score

Question 8

What is the rockall score?

Answer 8

Estimates the risk of bleeding and mortality after endoscopy

Question 9

What score is used to estimate the risk of bleeding and mortality after an endoscopy?

Answer 9

Rockall score

Question 10

What is the initial management of an upper GI bleed? (6)

Answer 10

• 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)

Question 11

What bloods should be done in upper GI bleed management? (5)

Answer 11

○ Haemoglobin (FBC)
○ Urea (U&Es)
○ Coagulation (INR and FBC for platelets)
○ Liver disease (LFTs)
Crossmatch 2 units of blood

Question 12

What transfusion is given to patients with massive upper GI bleeds?

Answer 12

Fresh frozen plasma
Blood, platelets and clotting factors

Question 13

What transfusion is given to patient who take warfarin that are actively bleeding?

Answer 13

Prothrombin complex concentrate

Question 14

What drugs are given to patients that have an upper GI bleed that you suspect is oesophageal varices? (2)

Answer 14

Terlipressin
Broad spectrum abx

Question 15

What is the use of terlipressin in oesophageal varices?

Answer 15

acts as a vasoconstrictor reducing portal venous pressure and controls variceal bleading

Question 16

Which type of abx are typically used in upper GI bleeds that are from oesophageal varices?

Answer 16

Broad spectrum typically quinolones

Question 17

What is the definitive diagnosis and management of an upper GI bleed?

Answer 17

Ogd

Question 18

What is done in an OGD for non-variceal bleeds to treat them? (2)

Answer 18

Clips
Thermal coagulation

Question 19

How is an OGD used to treat oesophageal varices?

Answer 19

Variceal band ligation

Question 20

When should PPIs be given to patients with non-variceal upper GI bleeding?

Answer 20

Not until after endoscopy

Question 21

What is a Sengstaken-Blakemore tube and what is it used for?

Answer 21

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.

Question 22

What is a transjugular intrahepatic portosystemic shunt and when is it used?

Answer 22

Connects hepatic vein to portal vein to stop variceal bleeding
If endoscopy and sengstaken-blakemore tube fail

Question 23

What is used in the prophylaxis of variceal haemorrhage? (3)

Answer 23

• 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

Question 24

What is an easy test to distinguish between an upper and lower GI bleed?

Answer 24

Upper GI bleed has high levels of urea
This is from breakdown of blood