Upper GI bleed Flashcards
what are some causes of non-variceal upper GI bleeds?
peptic ulcer disease gastritis/gastric erosions oesophagi's mallory weiss tear stomach cancer oesphageal cancer
what are some possible presentations of Upper GI bleeds?
Meleana
haematemesis
haemachezia
what are the two categories of upper GI bleeds?
variceal and non-variceal
what are the two scoring systems used for upper GI bleeds?
Glasgow- blatchford score
Rockall score
what is the glasgow-blatchford score used for?
used to stratify patients presenting to hospital with haematemesis into high and low risk groups
it predicts the need for endoscopy
what is the Rockall score?
predicts the risk of re-bleeding and mortality after an Upper GI bleed
The final score is a combination pre and post endoscopic findings
what investigations should you consider in an upper GI bleed?
emergency OGD Erect CXR (peroration --> pseumoperitoneum) CT Chest/abdo
when should you consider an emergency OGD?
suspicion of continuing upper GI bleed
suspicion of oesophageal varices
initial Rockall >3
pt has an aortic graft
what are the treatments for non-variceal upper GI bleeding?
mechanical haemostats (clipping) injection therapy (botox?) and thermal treatment
what are the treatments for variceal upper GI bleeding?
Band ligation, injection sclerosant therapy, sengstaken blakemore tube insertion
what is important to give patients post endoscopy for variceal bleed?
propranolol to lower portal HTN
What does TIPSS stand for?
Transjugular intrahepatic porto-systemic shunt
When is a TIPSS procedure done?
prophylactically or acutely if endoscopic therapy fails to control vatical bleeding.
what are the absolute contraindications to a TIPSS procedure?
severe pulmonary HTN, severe CCF, severe infection.
