Upper GI Bleed

Question 1

Name 4 causes of upper GI bleeds

Answer 1

• Peptic/duodenal ulcers
• Oesophageal varices
• Mallory-Weiss tear
• Stomach/duodenal cancer

Question 2

How will upper GI bleeds typically present? (4)

Answer 2

Melena
Haematemesis
“Coffee ground” vomit - vomiting digested blood
Haemodynamic instability - shock

Question 3

What 2 score systems are used in upper GI bleed?
What are both used to judge?
Which one should only be used for patients who have had an endoscopy?

Answer 3

Glasgow-Blatchford

• suspected upper GI bleed based on presentation
• used to establish risk of initial GI bleed

Rockall

• calculate risk of rebleeding and overall mortality
• used in endoscopy patients

Question 4

Why does urea increase in an upper GI bleed?

Answer 4

Urea is a breakdown product of blood - this is then absorbed by intestines

Question 5

An upper GI bleed will always be symptomatic. True or false?

Answer 5

False

Question 6

How do you manage?

Answer 6

ABATED

ABCDE
Bloods
Access (ideally 2 large bore cannula)
Transfuse
ENDOSCOPY (arrange urgent endoscopy within 24hrs) - this is most important
Drugs (stop anticoagulants and NSAIDS)

Question 7

What is the definitive treatment?

Answer 7

OGD (oesphagogastrodudoenoscopy)

Question 8

What is your first line treatment in acute variceal bleed?
Why?
What else should be given?

Answer 8

Terlipressin
- vasoconstriction of splanchnic vessels (reduces portal blood flow -> reduces portal blood pressure)

IV antibiotics

Question 9

What must be given for a bleeding peptic ulcer?

Answer 9

IV omeprazole - must reduce acidic conditions

Question 10

How many peptic ulcers are caused by H.pylori?

Answer 10

80% (just a wee fun fact)