Upper GI Bleed

Question 1

Glasgow Blatchford score

• Indication
• Criteria (7)

Answer 1

Used to asses the risk of someone with upper GI bleed needing medical intervention

• Blood transfusion
• Endoscopic intervention

Criteria

• Blood urea
• Haemoglobin
• Maleana
• Syncope
• Hear rate
• Hepatic/ cardiac failure

Question 2

Rockall score

• Indication
• Variables
• Intepretation

Answer 2

Score to assess risk of adverse outcome after upper GI bleed

Variables

• Age
• Blood pressure
• morbidity
• Diagnosis
• Evidence of bleeding

<3 is good prognosis, >8 is high risk of mortality

Question 3

Initial management of all upper GI bleed

Answer 3

Assess blood for Hb and clotting

1. Transfuse those with massive bleed
   - Blood
   - Platelets
   - Clotting factors
   - If not actively bleeding, NO platelet transfusion
2. Endoscopy of unstable patients after resus or within 24 hours of other patients

Question 4

Management of non-variceal bleeds

Answer 4

1. Firstly assess risk of bleed and undergo resus if necessary.
2. Endoscopy within 24 hours if not massively bleeding
3. Endoscopic treatment
   - Mechanical (clips)
   - Thermal coagulation with adrenaline
   - Fibrin/ thrombin with ADR
4. PPI given after if non-variceal
   - H.pylori Ag test if peptic ulcer seen
   - Antibiotic added if H.pylori confirmed.

Question 5

Management of re-bleed for non-variceal upper GI bleeds

Answer 5

1. Repeat endoscopy
   - further endoscopic treatment/ emergency surgery
2. IV radiology if unstable and re-bleed after previous endoscopic treatment.
3. Surgery if radiology not available

Question 6

Management of variceal bleeding

Answer 6

1. Terlipressin
   - For 5 days or after haemostasis
2. Antibiotics
3. Oesophageal
   - Band ligation
   - TIPS if bands don’t work

Gastric

• Endoscopic ‘glue’ injection (N-butyl-2-cyanoacrylate)
• TIPS if glue doesn’t work

Question 7

Primary prophylaxis for upper GI bleed in the acutely ill

Answer 7

1. Acid suppression therapy

- PPI or H2 antagonist

Question 8

Causes of upper GI bleeds

Answer 8

Main

• Peptic ulcers
• NSAIDs

Rarer

• Zollingster-ellison (gastrin secreting)
• Crohn’s
• Oesophageal/ gastric tumour
• Gastric ischaemia

Question 9

Upper GI bleed presentation

Answer 9

Anaemia

Fatigue

Malaena

Haematemesis

Syncope

Tachycardia/ hypotension

Weight loss

Signs of liver disease

• Ascites
• Splenomegaly
• Encephalopathy
• Thrombocytopenia