Upper GI bleed Flashcards
What are the causes of an upper GI bleed?
PUD Mallory-Weiss tear Variceal tear Oesophag/gast/duodenitis Malignancy
What are the RFs for an upper GI bleed?
OH-
Liver disease
Drugs (NSAIDs, Aspirin, Steroids, Anti-coag)
What is the Blatchford score used for?
Need for admission and endoscopic intervention (0-1 = discharge w/ OP OGD)
What is the Rockall Score used for?
Do pre & post-endoscopy
Predicts risk of Re-bleeding and mortality post-endoscopy (higher the score, worse the mortality)
What is the clinical presentation of an upper GI bleed?
Haematemesis Melaena Haematochezia Peripherally shut down Dyspnoea HypoT (dizzy/syncope) Tachycardia ↓GCS Abdo bruising
What bloods need to be sent in Upper GI bleed & why?
FBC: Anaemia
U+E: Raised Urea out of proportion to creatinine
LFT + Clotting: Low Vit K levels
Cross-match: 4-6units
How much blood needs to be cross-matched in an upper GI bleed?
Hb <80= 4-6units
(1u for each 10g/L)
Target Hb: 70-90
When should platelets be given in an upper GI bleed?
platelets <50 x10(9)
What is the management in a GI bleed?
- Omeprazole (PPI): 80mg IV bolus then 8mg/hr
- URGENT ENDOSCOPY (after rhesus within 24hrs of admission) +/- treatment
How is a variceal bleed treated?
IV Terlipressin 2mg QDS for 5days Prophylactic Broad spectrum antibiotics OGD: ACTIVE BLEED: Band ligation/ sclerotherapy/ balloon tamponade PROPANOLOL FOR LIFE
How is a non-variceal bleed treated?
Clips with/without adrenaline
When is a mallory-weirs tear bleed likely to happen?
Following repeated vomiting/dry retching
What are the features of a variceal bleed?
Large volumes
Haemodynamic instability
+/- malaena
Re-bleeds common
What bloods need to be taken in massive haemorrhage protocol?
FBC XM Clotting (INCLUDING Clauss Fibrinogen) U&E LFT Ca ABG
What should be considered in someone with a variceal bleed?
Liver disease
Look for signs of portal HTN
HEPATIC ENCEPHALOPATHY
