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Emergency Medicine > Upper GI bleed > Flashcards

Upper GI bleed Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is haematemesis?

A

Vomiting blood

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2
Q

What is malaena?

A

Black stools

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3
Q

What are causes of maleana?

A

GI haemorrhage/bleed

  • Peptic ulcer disease
  • Oesophageal varices
  • Oesophagitis
  • Gastritis
  • Mallory–Weiss tear
  • Neoplasm
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4
Q

What is the mechanism behind malaena?

A

Bleeding from any cause in the upper gastrointestinal tract can result in melaena. It is often said that bleeding must begin above the ligament of Treitz; however, this is not always the case.

The black, foul-smelling nature of the stool is due to the oxidation of iron from the haemoglobin, as it passes through the gastrointestinal tract.

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5
Q

What are common causes of upper GI bleeding?

A
  • Peptic ulcers
  • Mallory-Weiss tears
  • Oesophageal varcies
  • Gastritis/Gastric ulcers
  • Drugs
  • Oesophagitis
  • Duodenitis
  • Malignancy
  • No Obvious cause
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7
Q

What drugs can cause upper GI bleeding?

A
  • NSAIDs
  • Aspirin
  • Steroids
  • Thrombolytics
  • Anticoagulants
  • Alcohol
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8
Q

What would you want to ask someone who was presenting with features of an upper GI bleed?

A
  • Past GI bleeds
  • Dyspespsia/known ulcers
  • Known liver disease/oesophageal varices
  • Dysphagia
  • Vomiting
  • Weight loss
  • Drugs and alcohol use
  • Serious comorbidities - CVS, Resp, hepatic/renal, malignancy
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9
Q

What symptoms can occur in an acute upper GI bleed?

A
  • Haematemesis
  • Malaenia
  • Dizziness/Psotural Syncope
  • Abdo pain
  • Dysphagia
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10
Q

What signs might indicate someone is having an upper GI bleed?

A
  1. Signs of liver disease - telangiectasia, purpura, jaundice
  2. Signs of shock
  • Hypotension (SBP <100mmHg)/Postural drop >20 mmHg
  • Tacycardia
  • Decreased JVP
  • Decreased Urine output
  • CRT>2s
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11
Q

How would you manage someone having an acute GI bleed who was shocked?

A

ABCDE

  • Protect airway, give O2
  • Circulation assessment + 2 large bore cannulae
  • Rapid crystalloid infusion - Consider Blood transfusion if severe shock
  • Correct clotting abnormalities
  • Catheterise and monitor urine output
  • 15 minute obervations
  • Urgent endoscopy
  • Consider surgery if bleeding persists
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12
Q

What bloods would you perform if someone presented in shock from an upper GI bleed?

A
  • FBC
  • U+E’s
  • Clotting
  • Glucose
  • LFTs
  • Crossmatch
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14
Q

Why would you consider putting in a CVP monitor in someone recieving blood transfusion for an acute GI bleed?

A

To assess transfusion adequacy and overload on the heart

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15
Q

When would you consider transfusion in someone with an upper GI bleed?

A
  • Haemoglobin <80 g/L
  • Patients with active bleeding
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16
Q

What drugs would you want to check for (and stop) in someone having an acute GI bleed?

A
  • NSAID’s
  • Aspirin
  • Clopidogrel
  • Warfarin
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17
Q

What can be used to control uncontrolled variceal bleeding?

A
  • Trans-jugular intrahepatic porto-systemic shunt (TIPS)
  • Balloon tamponade - Sengstaken-Blakemore tube - compresses the varcies
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18
Q

What can cause Mallory-Weiss tears?

A

Sudden inicrease in intra-abdominal pressure

  • Heavy coughing
  • Heavy wretching/dry heaves
19
Q

How would you manage a varcieal bleed?

A
  • IV Terlipressin
  • Broad-spectrum IV antibiotics
  • Endotherapy - variceal ligation/Sclerotherapy
  • Correct any coagulopathies
21
Q

How would you manage bleeding ulcers?

A
  • Haemostatic therapy - 2 out of 3/3 out of 3 of clips, cautery or adrenaline
  • Post endoscopic PPI’s
  • Consider H. Pylori erdication therapy
  • Discontinue causative therapies - NSAIDs, aspirin
22
Q

What scoring systems are used to stratify Upper GI bleeds?

A
  • Glasgow-Blatchford bleeding score - initial risk assessment of acute upper GI bleed
  • Rockall score - identify patients at risk of complications following acute upper GI bleed
23
Q

What is coffee-ground vomit suggestive of?

A

Slow, intermittent bleed

24
Q

What is regarded as the point which distinguishes an upper GI bleed from a lower GI bleed?

A

Ligament of trietz

25
Q

Which does coffee-ground vomit indicate as a cause of haematemesis; peptic ulcers or variceal bleeding?

A

Peptic ulcers

26
Q

What would brisk haematemesis be indicative of as a cause?

A
  • Variceal bleeding
  • Actively bleeding gastro-duodenal ulcer
27
Q

What is haematochezia most commonly associated with; UGIB or LGIB?

A

LGIB - but can be upper in severe UGIB

28
Q

Why might urea be raised in an upper GI bleed?

A

As blood passes through the small bowel and is partially digested, it can result in an elevated urea and urea/Cr ratio - equivalent to a large protein meal

29
Q

What proportion of oesophageal varices will rebleed in a year?

A

60%

Emergency Medicine (32 decks)

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