Upper GI Bleed

Question 1

How much blood has entered the intestine if meleana present?

Answer 1

minimum of 250 ml

Question 2

What is the risk if patient has haematemesis?

Answer 2

aspiration if vomiting continues and px begins to lose consciousness

Question 3

Immediate tx of Upper GI bleed?

Answer 3

• ensure patency of airway
• high flow oxygen
• check patency of cannula (if fitted by paramedic)
• IV fluids
• Regular Obs
• Catheter to monitor output
• consider centra venous cannulation
• ECG and CXR to rule out other causes

Question 4

Bleeding varices; what is the problem if fluid balance management?

Answer 4

overtransfusion of px can cause continued bleeding by refilling the bleeding vessel.

Question 5

fluid management and beta blockers; what’s the problem?

Answer 5

Drugs can mask tachycardia; interpretation of pulse rate difficult

Question 6

What is the advantage of CVP line for px with high risk of bleeding?

Answer 6

Drop in CVP will usually precede the appearance of blood in vomit or stool

Question 7

Whats the mortality rate of upper GI bleeds?

Answer 7

15%

Question 8

Lab tests for Upper GI bleed

Answer 8

FBC, U & E, LFT, clotting and cross-match

Question 9

Fresh, red rectal bleeding is usually distal colon. When could this NOT be the case?

Answer 9

• rapid transit
• shortened bowel due to surgery
  *

Question 10

If not sure that fresh, red blood is from distal colon. What check can be done?

Answer 10

Urea: creatinine ratio ( >1:15 suggests proximal intestinal bleeding).

• blood is a high-protein meal

Question 11

Remember: bleeding from the proximal colon can also produce a black stool.

Answer 11

• chronic
• often anaemic present + iron deficiency

urea-creatinine ratio should be normal

Question 12

What symptoms would suggest haemodynamically unstable and a larger bleed?

Answer 12

history of syncope/ collapse/ light-headedness

Question 13

Complicating factors of upper GI bleed?

Answer 13

>> alcohol

anticoagulant use

recreational drug use (hepatitis/ chronic liver disease)

beta-blockers - mask tachycardia

comorbidities

Question 14

In what way does management of oesophageal varices differ from peptic ulcer

Answer 14

• higher mortality rate (50%)
• accurate fluid balance crucial; consider central venous cannula
• terlipressin 2g 5 hourly; splanchnic vasoconstrictor (reduces variceal blood flow) NB. this is not indicated for peptic bleeds.

Question 15

Possible causes of upper GI bleed

Answer 15

NSAIDs

h. pylori

>> alcohol

history of heartburn, etc.