Upper GI bleed Flashcards
What is upper gastrointestinal bleeding and where can it occur?
Upper gastrointestinal bleeding refers to bleeding from the oesophagus, stomach, or duodenum. It is a common medical emergency.
None
What are the key causes of upper gastrointestinal bleeding?
- Peptic ulcers (most common cause)
- Mallory-Weiss tear (tear of oesophageal mucosa)
- Oesophageal varices (due to portal hypertension from liver cirrhosis)
- Stomach cancers
None
What are the common symptoms of upper gastrointestinal bleeding?
- Haematemesis (vomiting blood)
- Coffee ground vomit (vomiting digested blood resembling coffee grounds)
- Melaena (black, tarry stools from digested blood)
- Haemodynamic instability may occur with significant blood loss, causing low blood pressure, tachycardia, and signs of shock.
None
How do peptic ulcers present in upper GI bleeding?
Peptic ulcers often present with epigastric pain and dyspepsia. Patients may also be using NSAIDs.
None
How does a Mallory-Weiss tear present in upper GI bleeding?
Mallory-Weiss tears are associated with heavy retching or vomiting, which may result from binge drinking, gastroenteritis, or hyperemesis gravidarum (in early pregnancy).
None
How do oesophageal varices present in upper GI bleeding?
Oesophageal varices are associated with liver cirrhosis and portal hypertension, presenting with signs of these conditions such as ascites, jaundice, and caput medusae.
None
How does stomach cancer present in upper GI bleeding?
- Weight loss
- Epigastric pain
- Treatment-resistant dyspepsia
- Low haemoglobin (anaemia)
- Raised platelet count
None
What is the Glasgow-Blatchford Bleeding Score used for?
The Glasgow-Blatchford Bleeding Score helps estimate the risk of upper GI bleeding at the initial presentation. A score above 0 indicates high risk. Consider early discharge for patients with a score of 0.
Factors considered in the score include haemoglobin, urea, blood pressure, heart rate, melaena, syncope, liver disease, and heart failure.
What is the Rockall Score used for?
The Rockall Score is used after endoscopy to estimate the risk of rebleeding and mortality. It considers age, features of shock, co-morbidities, cause of bleeding, and endoscopic findings.
None
What is the ABATED mnemonic for managing upper GI bleeding?
- A – ABCDE approach to resuscitation
- B – Blood tests
- A – Access (2 x large bore cannulas)
- T – Transfusions
- E – Endoscopy (within 24 hours)
- D – Drugs (stop anticoagulants and NSAIDs)
None
What blood tests are important in the management of upper gastrointestinal bleeding?
- Haemoglobin (Full Blood Count, FBC)
- Urea (U&Es)
- Coagulation profile (INR and platelet count)
- Liver function tests (LFTs)
- Crossmatch 2 units of blood
None
What guidelines are followed for blood transfusions in upper GI bleeding?
- Massive bleeding: Blood, platelets, and clotting factors (fresh frozen plasma)
- Thrombocytopenia: Platelets are given if platelet count is below 50 in active bleeding
- Warfarin patients: Prothrombin complex concentrate for active bleeding
None
What additional treatments are needed if oesophageal varices are suspected?
- Terlipressin
- Broad-spectrum antibiotics
- Endoscopy: Required to diagnose and treat the bleeding source (e.g., variceal band ligation for bleeding varices).
None
What role does endoscopy play in managing upper GI bleeding?
Endoscopy (OGD) helps diagnose and treat the bleeding source. Non-variceal bleeding can be treated with clips or thermal coagulation, while variceal bleeding requires band ligation.
None
What do the NICE guidelines say about proton pump inhibitors (PPIs) in upper GI bleeding?
The NICE guidelines (2016) recommend not using proton pump inhibitors (PPIs) until after endoscopy in patients with non-variceal upper GI bleeding.
None
