upper GI bleed Flashcards
symptoms
haematemsis
coffee ground vomiting or malaena
what is severity measured by
the 100 rule systolic BP <100 pulse >100 Hb <100 age >60
treatment of bleeding
resuscitate patient, ABCDE approach
protect airway , O2 and IV fluids
correct clotting abnormalities
what is risk assessed with
blatchford or rockall score
what are clotting abnormalities corrected with
vitamin K, platelets and FFP
what clotting factor is used if all else fails
recombinant factor VIIa
investigations
endoscopy, FBC, crossmatch blood, CXR, CT
treatment of non variceal bleeding
Endoscopy – clips with/without adrenaline, thermal coagulation with adrenaline, fibrin or thrombin with adrenaline
if rebleed (non variceal) occurs what after adrenaline injection what do u do
give omeprazole then endoscopy
if bleeding continues -surgery
how do varices arise
Portal hypertension – inc. CO – splanchnic vasodilation – salt and water retention – hyperdynamic circulation/inc. portal flow – formation of collaterals between portal and systemic systems
above what pressure do gastro-oesophageal varices arise
10mmHg
what is the most common cause of death in cirrhosis
varice
treatment for variceal bleedin
o Resuscitate until haemodynamically stable
o Correct clotting abnormalities with vitamin K, FFP (fresh frozen plasma) and platelet transfusion
o Terlipressin/somatostatin analogues(less used in UK), prophylactic antibiotics
o Sclerotherapy or endoscopic banding
o Balloon tamponade with Sengestaken Blakemore tube if bleeding uncontrolled.
o Failures are best managed by TIPS
prophylaxis of variceal bleeding
BB blocker
elective endoscopic variceal banding ligation
TIPS
in life threatening variceal bleeding what can buy time before transfer over to specialist
Balloon tamponade with Sengestaken Blakemore tube
