Upper GI bleed

Question 1

when would you give a blood transfusion in a patient with upper GI bleeding?

Answer 1

lost 30% circulatory volume

Hg < 90 g/l

Question 2

describe the management of a variceal bleed.

Answer 2

1st line: endoscopy
- rubber band ligation or sclerotherapy

IV terlipressin (continue for 72 hours)

prophylactic antibiotics i.e. fluoroquinolone - ciprofloxacin

lactulose

sucralfate (protects post banding fragile mucosa)

Question 3

describe the management of an upper GI bleed not variceal.

Answer 3

1st line: endoscopy

combination of adrenaline injection + thermal or mechanical treatment

+ IV bolus PPI 80mg then 8mg/hr for 72 hours

Question 4

what are indications for surgery?

Answer 4

re-bleed in patient > 60 yrs
uncontrolled bleeding (> 6 units on admission or > 1 unit within 8 hours)
unsuccessful with endoscopic treatment
high risk bleeds
known CV disease and poor response to hypotension

Question 5

how would you manage a bleeding ulcer that cannot be treated endoscopically?

Answer 5

gastric: under running of ulcer
- partial gastrectomy if in antrum
- partial gastrectomy or under running if in lesser curvature
- total gastrectomy if bleeding persists

duodenal;
- laparotomy, duodenostomy and under running of ulcer

Question 6

what risk stratification is used to determine risk of re-bleed and mortality?

Answer 6

rockall score

< 3 is associated with low mortality

Question 7

what risk stratification is used to determine severity of bleed and need for admission?

Answer 7

Glasgow blatchford score

• haemoglobin
• urea
• pulse rate
• systolic BP

admit if score > 1