Upper GI Bleed Flashcards
Name the potential causes of an upper GI bleed
- Duodenal ulcer
- Gastric erosions/ ulcer
- Varices/ Mallory-Weiss tear
- Oesophagitis
- Erosive duodenitis
- Cancer
- stomal ulcer/ oesophageal ulcer
How do you manage a patient who presents with an Upper GI bleed?
- medical emergency
=> ABCDE
Airway protection
Oxygen
IV access
Fluids
To assess the severity of a haemorrhage, doctors can use the “100 Rule”. What does this mean?
The 100 rule identifies the group with poor prognosis
systolic BP < 100mmHg pulse > 100/min Hb < 100 g/l age > 60 comorbid disease postural drop in blood pressure
What score is used in NHS Tayside to determine the management of patients with an Upper GI bleed?
Blatchford score
This takes into account:
- Blood urea level
- Hb
- Systolic BP
other markers are HR, melaena, syncope, and pre-existing conditions
What Blatchford scores indicate a mild, intermediate or high risk?
MILD = 0-1 INTERMEDIATE = 2-5 SEVERE = >5
How can acutely bleeding peptic ulcers be treated?
- Endoscopic treatment (high risk ulcers)
- Acid suppression (IV omeprazole)
- Interventional radiology
- Surgery
ALSO (H. pylori eradication - secondary prevention)
What can be used during endoscopic treatment of a peptic ulcer to stop the bleeding?
- Injection (adrenaline)
- Heater probe coagulation
- Clips
- Haemospray
Describe how haemospray works to stop a peptic ulcer from bleeding
When Haemospray comes in contact with blood:
- powder absorbs water
- acts both cohesively and adhesively
=> mechanical barrier over the bleeding site
Describe what happens if a peptic ulcer rebleeds after achieving haemostasis?
- Omeprazole is still given IV
- Endoscopic therapy is re-attempted
- if bleeding continues => Interventional radiology or surgery
If a peptic ulcer bleed is unable to be contained by endoscopic therapy, what is the next step?
Interventional radiology or surgery
In what patients should you expect that an upper GI bleed may be from oesophageal varices?
Known Hx of:
- cirrhosis
- chronic alcohol excess
- chronic viral hepatitis infection
- metabolic or autoimmune liver disease
- intra-abdominal sepsis/surgery
O/E
- spider naevi
- palmar erythema
- ascites
- jaundice
How is haemostasis achieved in patients with bleeding varices?
- Terlipressin (vasopressin analogue)
- Endoscopic variceal ligation (banding)
- Sclerotherapy
- Sengstaken-Blakemore balloon
- TIPS
What is Terlipressin used for in bleeding varices?
- It is a vasopressin prodrug
- Works predominantly to vasoconstrict the splanchnic vessels
- Has a beneficial effect on renal perfusion unlike other drugs of its type
Describe how Endoscopic variceal ligation (EVL) works
- make a little outpouching of the varices into the lumen
- band the bottom of this outpouching to prevent bleeding
What is sclerotherapy?
- drug injected into the variceal vessels to make them shrink
