Upper GI bleed

Question 1

Definition: Melena

Answer 1

black “tarry” feces (associated with upper GI bleed)

Question 2

Definition: haematemesis

Answer 2

Vomiting of blood

Question 3

Definition: coffee ground vomiting

Answer 3

a particular appearance of vomit.
Within organic heme molecules of red blood cells is the element iron, and when this iron has been exposed for some time to gastric acid, it becomes oxidized.
This reaction causes the vomitus to look like ground coffee.
Coffee-ground vomitus is a classic sign of upper gastrointestinal bleeding.

Question 4

Pathiophysiology behind oesophageal varices

Answer 4

Insult to liver leading to cirrhosis and portal hypertension

Causes opening of collateral veins

Question 5

General Management of upper GI bleed

Answer 5

Assess likelihood of varices
2 large bore cannulas
G&S or cross matched blood
Fluid then blood resuscitation
Correction of clotting
Move to appropriate ward area (acute)
Arrange endoscopy

Question 6

Management of varices

Answer 6

Terlipressin (vasoconstriction)
Antibiotics
Lactulosr
Secondary prophylaxis: beta blockers, banding
Balloon tamponade (short term rescue)

Question 7

Management of ulcers

Answer 7

Most bleeding stops spontaeously

Endoscopy
Pharm: PPI (post endoscopy)
Radiological

Question 8

Definiton: Haematochezia

Answer 8

the passage of fresh blood through the anus, usually in or with stools (often associated with lower GI bleed but can be associated with upper GI bleed)