Upper GI Bleed

Question 1

Haematemesis is

Answer 1

Blood in vomit

Question 2

How to assess airway

Answer 2

Clear/on oxygen/ patient talking/ need to keep reassessing in view of vomiting

Question 3

How to assess breathing

Answer 3

Look listen and feel/ chest expansions + sats

Question 4

Assess circulation

Answer 4

Looks pale/ peripheral temp/ cap refill

Question 5

Immediate management for GI bleed

Answer 5

Call help

2 large bore IV cannula

Take bloods

IV fluids

ABG/ lactate/HB/electrolytes

Catherter

Keep NBM

15 minute obs

Question 6

Every GI bleed needs which examination

Answer 6

Rectal exam

Question 7

Treatment of GI. Bleed

Answer 7

Stop offending drugs

Give blood if needed

Correct clotting (less than 1.5 INR)

Platelet transfusion if under 50

Consider antibiotics if risk f aspiration or varices

Question 8

Causes of UGIbleeds

Answer 8

Malloy Weiss tear
Oseophagitis

Oesophageal varices

Peptic ulcer

Malignancy

Drugs

Angiodysplasia

Aortoenetric fistula

Question 9

Before administering specific treatment you should make sure that?

Answer 9

You know if it’s a varicella or non varicella (peptic ulcer)

Question 10

If variceal then

Answer 10

Give terlipressin(always have ecg before the terlipressin)

Question 11

Terlipressin is analogue do and does

Answer 11

Analogue of vasopressin

Causes vasoconstriction

Question 12

Careful with first dose of terlipressin why

Answer 12

ECG before and after first dose as it can cause heart attacks in prone people

Question 13

Non variceal treatment

Answer 13

Give pantoprazole infusion - 80 mg IV stat then 8mg/hr for 72 hours

Question 14

Risk stratification is

Answer 14

Blatch- ford score

Question 15

Blatchford score is between ?

When is 50% risk of needing an intervention

Answer 15

0-6

3

Question 16

What can’t blatchford predict

Answer 16

Morality

Question 17

When is endoscopy needed

Answer 17

-Severe bleed 6+
Urgent OGDonce resuscitated
Will need protected airway

Mild/moderate bleed

OGD within 24hrs of admission

Question 18

Which score used for morality

Answer 18

Rock all score

Question 19

After OGD

Answer 19

Continue PP8, terlipressin,antibiotics as advised

Rock all score

Clear fluid after an hour

Light diet after 6 hours

Monitor signs of rebleeding

Question 20

Other things to consider post OGD

Answer 20

Peptic ulcer-

Check and eradicate H.pylori
Omeprazole 40mg OD/BD 8 weeks

Repeat score in 6-8 weeks

• varices

Propranolol or carvediol
Endoscopic banding every 2-4 weeks

Question 21

Peptic ulcer is risk of

Answer 21

Malignancy

Need to stop smoking