Upper GI Bleed Flashcards
1
Q
How can a patient present with an upper GI bleed?
A
- Haematemesis and/or malaena
- Epigastric discomfort
- Sudden collapse
2
Q
What are the causes of oesophageal bleeding?
A
- Oesophagitis
- Cancer
- Mallory Weiss Tear
- Varices
3
Q
What are the causes of gastric bleeding?
A
- Gastric cancer
- Diffuse erosive gastritis
- Gastric ulcer
4
Q
What is the most common cause of a major upper GI bleed?
A
Posterior sited duodenal ulcer
5
Q
How does a oesophageal variceal bleed present?
A
- large volume of fresh blood
- swallowed blood may cause malaena
- hyodynamic compromise
- Alcohol hx
- May stop spontaneously but re-bleeds common
6
Q
What is the management of an upper GI bleed?
A
- A-E assessment +GCS
- MASSIVE BLEED: Crossmatch and transfuse O- blood immediately (based on BP, Hr, Hb and visualisation or blood loss)
- Blatchford score at first assessment
- Endoscopy -offered immediately after resus in unstable patient or if stable within 24hrs
- Rockall score post endoscopy
- Management of specific cause of bleed
7
Q
What are the endoscopic management options of a non-variceal bleed?
A
- Endoscopy clips with/without adrenaline
- Thermal coag with adrenaline
- Fibrin/thrombrin with adrenaline
8
Q
What are the endoscopic management options of a variceal bleed?
A
- Telipression
- Gastric: endoscopic injection TIPS
- Oesophageal band ligation or TIPS
9
Q
What should patients with oesophagitis/gastritis receive?
A
Proton pump inhibitor
10
Q
What should patients who have received intervention receive to reduce re-bleeding rate?
A
Proton pump inhibitor IV omeprazole for 72hrs
11
Q
What are the indications for surgery in an upper GI bleed?
A
- Patients >60years
- Continued bleeding despite endoscopic intervention
- recurrent bleeding
- known cardiovascular disease with poor response to hypotension
