Upper GI Bleed Management Flashcards
What are the key symptoms of haemorrhage in upper GI bleed?
Haematemesis
Melaena
Signs of IDA (fatigue, palpitations, syncope)
Haematemesis refers to vomiting blood, while Melaena is characterized by black, tarry stools.
What anticoagulants should be considered in cases of upper GI bleeding?
Warfarin
DOACs (rivaroxaban and apixaban)
NSAIDs
What are the complications of chronic liver disease (CLD) to look for?
Jaundice
Pruritus
Ascites
These complications can indicate worsening liver function.
What are the differential diagnoses for esophageal causes of upper GI bleeding?
Esophageal varices
Oesophagitis
Cancer
Mallory-Weiss tear
Symptoms like dysphagia and weight loss may suggest cancer.
What are some gastric causes of upper GI bleeding?
Gastric ulcer (prandial pain)
Cancer
GAVE syndrom (Gastric antral vascular ectasia)
Diffuse erosive gastritis (NSAID use)
Gastric ulcers often present with prandial pain and symptoms of IDA.
What are duodenal causes of upper GI bleeding?
Duodenal ulcer (postprandial pain)
Aorto-enteric fistula (Previous AAA Surgery)
What are the stigmata of chronic liver disease during physical examination?
Clubbing
Palmar erythema
Scleral icterus
Spider naevi
Gynaecomastia
Caput medusa
Ascites
Hepatomegaly
Scores to asses severity of upper GI bleed?
Glasgow-Blatchford score:
- assess need for medical intervention (e.g. transfusion) or urgent endoscopy
- Score of 0: considered for early discharge and outpatient management
Rockall score:
- pre- and post endoscopy
- determines severity of upper GI bleeding
- A higher score indicates greater risk of mortality.
What blood tests are essential in the assessment of upper GI bleeding?
FBC (anaemia, thrombocytopenia)
U&E (isolated increase in urea indicates an upper GI bleed)
LFTs (Cirrhosis)
Coag Studies (INR, coagulopathy)
Amylase
VBG (lactate)
Albumin (synthetic liver function)
Hepatitis screen
What is the recommended timing for urgent endoscopy in unstbale vs. stable patients?
Unstable: immediately
Stable: within 12 hours
What are the initial management steps for a patient with upper GI bleed?
Make NPO
Correct coagulopathy
NPO stands for ‘nil per os,’ meaning nothing by mouth.
What medications are used to correct coagulopathy in upper GI bleeding?
Warfarin: vitamin K, FFP/PCC
DOACs (rivaroxaban, apixaban): andexanet alfa
DOACs (dabigatran): idarucizumab
Thrombocytopenia: platelet transfusion
What medications are given in suspected variceal bleeds to reduce the rate of rebleeding and prevent sponatenous bacerial peritonitis (SBP)?
Prophylactic ABx (ciprofloxacin)
Suspected variceal bleed:
■ Terlipressin (splanchnic vasoconstrictor) continued for 3-5 days
■ Octreotide (somatostatin analogue) - may also be given
What are the endoscopic treatments for Ulcers in upper GI bleeding?
Adrenaline injection
Thermal / laser coagulation
Fibrin glue
Endoclips
Hemospray / endoclot
What are the endoscopic treatments for Varices in upper GI bleeding?
Endoscopic banding
Histoacryl glue for gastric varices
Balloon tamponade with Sengstaken-Blakemore tube
- Stored in fridge
- Will cause pressure necrosis after 24 hours
What are the indications for surgery in cases of upper GI bleeding?
Rebleeding
Bleeding uncontrolled by endoscopy
Transfusion of 6 units
High Rockall score (>3 initially, >6 finally)
These criteria help determine when surgical intervention is necessary.
What follow-up care is recommended post-endoscopy for severe bleeding?
TIPSS
IV pantoprazole 80 mg BD
Daily bloods
H. pylori testing and eradication
What tests are used for H. pylori detection?
Urea breath test
CLO test
Serum antibodies
Stool antigen
These tests help confirm H. pylori infection before eradication treatment.
What is TIPSS?
TIPSS, or Transjugular Intrahepatic Portosystemic Shunt, is a medical procedure used to treat portal hypertension, a condition where blood pressure in the portal vein (which carries blood from the digestive organs to the liver) becomes abnormally high. This procedure creates a new passage between the portal vein and a hepatic vein (which carries blood out of the liver) to help relieve pressure and prevent complications like variceal bleeding and ascites.
What is the treatment of H. Pylori?
Tripple Therapy:
* Two Antibiotics: amoxicillin, clarithromycin, metronidazole, and tetracycline.
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* Proton Pump Inhibitor (PPI): Omeprazole, pantoprazole
- Duration: A typical treatment course lasts for 10-14 days.
