Upper GI Bleed

Question 1

Definition

Answer 1

Bleed where the site is proximal to the ligament of Treits at the duodenal junction

Question 2

Which part of the history would make you think of a variceal origin?

Answer 2

Brisk haematemesis

Question 3

Epidemiology

Answer 3

50-100/100K
Highest incidence in lower socioeconomic areas
2:1 M:F

Question 4

Common causes of UGIB

Answer 4

PUD (40%)
Acute erosions
Mallory Weiss
Varices
Oesophagitis
Ca

Question 5

RFs for UGIB

Answer 5

Comorbidities
Portal HTN
Acute stress
NSAIDs
History/ongoing alcoholism

Question 6

Initial rockall score criteria

Answer 6

Age
Shock: BP, pulse
Comobidities

if >3 - surgery

Question 7

Final roackalls core criteria

Answer 7

Final Dx + evidence of recent haemorrhage

Initial + Final >6 = surgery

Question 8

Prognosis of UGIB

Answer 8

40% of rebleeders die

ROCKALL score predicts risk of rebleed and mort

Question 9

Presentation of UGIB

Answer 9

Fatigue
Dizzy
Syncope
Haematemesis
Melaena on PR
Low BP
Cool and clammy
Tachycardic
Low GCS

Question 10

Cause of oesophageal varices

Answer 10

Portal HTN = dilated veins at sites of porto-sytemic anastamosis: L GASTRIC AND INF. EOSOPHAGEAL VEINS

Due to: portal vein thrombosis, cirrhsosis, sarcoidosis, schisto

Question 11

Management of suspected varicieal bleed

Answer 11

RESUS
BLOODS
VASOPRESS w/ terlipressin
PROPHYLACTIC ABX
IV FLUIDS w/ crystalloid