Upper GI bleed Flashcards
What is the presentation?
- haematemesis +/-melena
- epigastric discomfort
- sudden collapse
- may have signs of chronic liver disease
What are the causes?
peptic ulcers mallory weiss tear oesophageal varices gastritis/erosions drugs oesophagitis duodenitis malignancy
What are the drugs that cause?
NSAIDs
steroids
aspirin
What is the acute management?
- Protect airway + high flow O2
- Insert 2 large bore cannulae + take bloods for: FBC, U+E, LFT, CLOTTING, CROSSMATCH
- IV fluids
- Urinary catheter - UO + consider CVP line to guide fluid replacement
- ABG, CXR, ECG
- Transfuse if Hb <70
- Correct clotting abnormalities (vit K, FFP, platelets)
- Urgent endoscopy - all should have <24hrs
- If endoscopic control fails - surgery or mesenteric angiography/embolisation
What specific management would you add for varices?
IV terlipressin prior to endoscopy
broad spec IV abx - piperacillin/taxobactam 4.5g/8hr
Sengstaken-Blakemore tube to compress varices
What score is used to risk stratify upper GI bleeds
rockall score
What features would suggest the patient is shocked?
cool peripheries clammy CRT >2 UO <0.5/kg/hr Reduced GCS or encephalopathy HR >100 Systolic BP <100, postural drop >20
What is the Glasgow-blatchford bleeding score?
Stratifies upper GI bleeding patients who are “low-risk” and candidates for outpatient management.
What may suggest mallory-weiss tears as a cause?
vomiting preceding the bleed
What are MW tears? Who are they common in?
Severe vomiting → painful mucosal lacerations at the gastroesophageal junction resulting in haematemesis. Common in alcoholics
how would you differentiate between a peptic and duodenal ulcer?
duodenal ulcers cause pain when hungry and relieved by eating
gastric ulcer pain is worsened by eating g
What are oesophageal varices a complication of?
portal HTN in cirrhosis causing portosystemic shunt
What urea would u see in upper GI bleeding?
raised out of proportion to creatine due to blood meal
When would you avoid giving saline?
if varices or cirrhotic
