Upper GI bleed

Question 1

haematemesis DDx? mnemonic

Answer 1

VINTAGE

Varices

Inflammation- PUD

Neoplasia- oesophageal or gastric cancer

Trauma – Mallory-weiss tear

Angiodysplasias

Generalised bleeding diathesis/ Gastritis

Esophagitis

Question 2

presentation?

Answer 2

• haematemesis
• “coffee ground vomit”
  
  • caused by vomiting partly digested blood
• melaena
  
  • tar like, black, greasy, offensive stools caused by digested blood

Question 3

signs?

Answer 3

shock

Question 4

Ix?

Answer 4

• Glasgow Blatchford score
  
  • establishes risk of someone having UGIB on initial presentation. score > 0= high risk
• Rocketall score
  
  • used for pts who have had an endoscopy
  • provides a % risk of re-bleeding and mortality
  • based on age, co-morbidities, features of shock, features seen on endoscopy of recent haemorrhage

Question 5

Mx: mnemonic

Answer 5

ABATED

ABCDE approach to immediate resus

Bloods

• FBC (Hb)
• U&E
• LFTs
• Coag screen
• Crossmatch 2 units

Access: 2 large bore cannula + IV fluids

Transfuse

Endoscopy

Drugs - stop anticoagulants and NSAIDs

Question 6

what do you transfuse?

Answer 6

• Blood, platelets & clotting factors in massive haemorrhage
• Platelets in active bleeding and thrombocytopenia
• Prothrombin complex concentrate to pts taking warfarin who are actively bleeding

Question 7

what drugs do you give in variceal bleed?

Answer 7

Terlipressin IV + broad-spectrum Abx

Question 8

what is definitive treatment?

Answer 8

OGD to provide interventions to stop the bleeding

*only give PPI once endoscopy done, if required*

Question 9

why is there a rise in urea in UGIB?

Answer 9

because blood in GIT gets broken down and urea is by-product of this, and then gets absorbed in the intestines

Question 10

what % of ppl w portal HTN will bleed from varices?

Answer 10

30-50%