upper GI bleed TBL Flashcards
where is haematemesis blood from?
proximal to jejunum
usually fresh
where is malaena blood from?
proximal to caecum
What is haemobilia?
blood in biliary tree
what does fresh red blood indicate?
coming from a vessel
what are some signs of a large bleed?
dizziness postural syncope collapse short of breath altered consciousness
do all patients with upper GI bleed get a PR exam?
yes
how is upper GI bleed managed?
ABCD A - ensure patent airway B - oxygen C - bloods including cross match, 2 large bore cannula, recus with blood/fluids D - glucose consider referral consider drugs (PPI for ulcer, terlipressin + IV co-trimoxazole in variceal bleeds) Treat possible clotting abnormalities - IV Vit K - FFP/cryoprecipitate - Berriplex (if on warfarin) - Platelets
which cannula is used?
purple
large bore
what is the Blatchford score?
stages severity of bleed
only score of 0 or 1 can go home
oesophageal cancer picture?
progressive dysphagia to solids then liquids (slow growing tumour) appetite loss weight loss iron deficiency anaemia odynophagia (pain on swallowing)
what is palliative treatment for oesophageal cancer?
stent
allows patient to eat and drink
what is the most likely cause of iron deficiency anaemia in over 50s?
oesophageal cancer
where is a Mallory Weiss tear likely to occur?
gastro-oesophageal junction
cause of GI bleeding in people with joint pain?
ulcer
as likely to take many painkillers
what is a gold probe?
heat coagulation
often occurs with injection of adrenaline
what are clips used for?
Mallory Weiss tear
visible vessel
what is APC?
argon plasma coagulation
used in GAVE, oozing bleeding not active
Liver disease + massive GI bleed?
oesophageal varices
what is banding used for?
oesophageal varices (not gastric)
what predicts sever upper GI bleed?
pulse of 110
liver disease
postural BP drop
jaundice, spider naevi, ascites, haematamesis, malaena?
oesophageal varices
what causes portal hypertension
pressure gradient between hepatic and portal vein rises above 10-12 so blood backs up into colaterals
what are some possible collaterals in portal hypertension?
oesophagus
spleen
rectum
if someone is having massive bleed?
massive haemorrhage protocol
medium bleed?
O negative blood
small bleed?
Alba
dextrose
what medication given?
septrin (co-trimoxazole)
INR>2?
IV Vit K
spots of blood on oesophageal varices (Nickel sign?)
banding
oesophageal varices > banding > bleed stops > rebleed, what next?
Recuss
Insert C sengstaken blakemore tube and inflate balloon to stabilise bleed before TIPS can be performed
oesophageal varices > banding > bleed stops > rebleed, what next?
Recuss
Insert C sengstaken blakemore tube and inflate balloon to stabilise bleed before TIPS can be performed
