Upper GI bleed

Question 1

ABCDE assessment

Answer 1

IV fluid resus
Massive haemorrhage protocol if massive blood loss
Blood transfusion if Hb < 7 in variceal bleed or 8 in non-variceal bleed
Pt must be haemodynamically stable before endoscopy

Examination, bloods (G&S, FBC, U&E, LFTs, clotting, glucose), catheterise, CXR and AXR, OGD, obs

Question 2

Acute variceal bleed

Answer 2

Terlipressin or octreotide - give before endoscopy to reduce portal flow

Variceal band ligation
Sclerotherapy

Balloon tamponade

Question 3

Non-variceal bleed (e.g. peptic ulcer, MWT, oesophagitis)

Answer 3

Adrenaline injection to peptic ulcer

IV PPI after endoscopy

Question 4

In all patients

Answer 4

Correct clotting abnormalities:
Warfarin - PCC, vitamin K
DOAC - Praxbind for dabigatran, PCC for others
Platelets < 50 : platelet transfusion
Fibrinogen < 1: FFP / cryoprecipitate

Stop anticoagulants or antiplatelets
Prophylactic abx if variceal bleed
Tx concurrent issues

Question 5

Scoring systems

Answer 5

Glasgow-Blatchford score (pre-endoscopy): assesses likelihood pt will need intervention

Rockall score (post-endoscopy): mortality risk assessment

Question 6

Preventing further bleeding

Answer 6

Oesophageal varices - propranolol, variceal banding, transjugular intrahepatic portosystemic stent (TIPSS), liver transplant

Peptic ulcer - PPI, H. pylori eradication, avoid precipitants