Upper GI bleed Flashcards
How does an upper GI bleed present?
Haematemesis:
- Acute bleed is bright red and can be caused by Mallory-Weiss tears, ulcers, varices.
- Chronic bleed is coffee-ground and can be caused by oesophagitis and gastritis.
Malaena
What are the risk factors for an upper GI bleed?
Previous GI bleeds Peptic ulcers Liver disease Oesophageal varices NSAIDs Excess alcohol consumption Dysphagia Weight loss
Warfarin, NOACs, aspirin etc don’t cause bleeds independently but can exacerbate the initial cause.
What is the Rockall Risk Score and what does it consist of?
It is used to calculate a score of MORTALITY.
Pre-endoscopy: Age, BP/HR, comorbidity status
Post-endoscopy: Diagnosis, signs of recent GI bleeds
What is a Mallory-Weiss tear?
It occurs after prolonged and vigorous retching and vomiting.
Due to a tear in the oesophageal-gastric junction.
Usually stops by itself.
What are oesophageal varices, their presentation, risk factor and treatment?
It is submucosal venous dilation secondary to portal hypertension.
Sudden onset, painless, dark red haematemesis.
Can bleed profusely secondary to loss of clotting factor production which is seen in liver disease.
HIGH SUSPICION IF ALCOHOL HISTORY.
TREATMENT: IV terlipressin and urgent upper GI endoscopy.
What are the causes of an upper GI bleed?
Mallord-Weiss tears Peptic ulcer Oesophageal varices Gastritis Oesophagitis Duodenitis NSAIDs/steroids Malignancy Angiodysplasia
What is the management of an upper GI bleed?
ABCDE approach - take bloods - IV fluids - urinary catheter - ABG - transfuse until haemodynamically stable - correct clotting abnormalities - urgent endoscopy (during which can identify cause, give sclerotherapy (inject into vessels to make them shrink), adrenaline or banding - omeprazole post-endoscopy.
SURGERY: If severe bleeding despite a 6 unit transfusion, rebelling, uncontrollable bleeding.
