Upper GI Bleed / Oesophageal Varices

Question 1

What is haematemesis?

Answer 1

Vomiting of fresh or altered blood; source proximal to ligament of Treitz.

Question 2

Source of bleeding in malaena?

Answer 2

Blood has undergone partial digestive action: source proximal to ileocaecal valve.

Question 3

How to ascertain if bleeding haemodynamically significant?

Answer 3

1) external evidence of >500mL blood loss
2) resting tachycardia
3) systolic BP

Question 4

What is orthostatic hypotension defined as?

Answer 4

Pulse increase >20bpm or decrease in SBP of >20mmHg.

Question 5

Most common causes of upper GI bleeding?

Answer 5

• PUD - 45%
• Oesophageal varices - 15%
• Gastroduodenal erosions - 10%

Question 6

Risk stratification score for patients with upper GI bleed?

Answer 6

A. Blatchford Score:
-SBP
-BUN
-Hb
-Pulse
-Melaena
-Syncope
-Hepatic disease
-Cardicc failure
B. Rockall Score

Question 7

Mx at presentation of upper GI bleed?

Answer 7

• Assess haemodynamics
• FBE / UEC / INR / Cross match and hold
• Initiate resuscitation
• Consider NGT
• ?IV PPI
• Early endoscopy
• Risk stratification

Question 8

Aetiology of oesophageal varies?

Answer 8

almost always portal HTN

Question 9

Mx oesophageal varices?

Answer 9

1) assess haemodynamics and resuscitate
2) IV octreotide
3) Endoscopic varciceal ligation

Question 10

Long term treatment to decrease risk of recurrent oesophageal bleed?

Answer 10

• B blocker
• Repeat EVL
• Nitrates
• FOllow up

Question 11

Treatment of persistent or recurrent bleed?

Answer 11

• TIPS
• Balloon tamponade
• Liver transplant