Upper GI Bleeding (1*) Flashcards
What is its most common cause?
→ What are the key risk factors for this?
What are its other causes?
➊ Peptic Ulcer Disease
→ H.pylori, NSAID use, Smoking
➋ • Mallory-Weiss tear
‣ Due to rupture of the gastro-oesophageal junction after repetitive retching
• Oesophageal varices
• Malignancy
Presentation:
What is 1 of the main ways in which GI bleeds present?
→ In which bleeds will this occur in? Why?
What is another main way in which GI bleeds present?
What will there be with a large bleed?
→ What is the 1st sign seen here?
→ What is important to check for in order to not miss this early sign?
What could other signs relate to? Give examples
➊ Haematemesis (frank blood or coffee-ground material)
→ Those from the mouth to the 2nd ½ of the duodenum as retroperistalsis only occurs from this point upwards
➋ Melaena (black, tarry, greasy, foul-smelling stools)
➌ Haemodynamic instability - Hypotension, Tachycardia, Drop in urine output, Cold and clammy peripheries
→ Tachycardia
→ Their drug chart for b-blockers as it could mask any haemodynamic compromise during its early stages
➍ An underlying pathology
• Epigastric pain and Dyspepsia/Indigestion - Peptic ulcers
• Jaundice, ascites, and alcohol hx - Oesophageal varices
Management:
What is the main intervention to do in the A-E assessment?
→ What is the aim when doing this?
What are 2 urgent things to do?
Which Bloods should be done?
→ Why would Urea be raised here?
What type of access needs to be done?
→ What needs to be considered when trying to do this in these types of pts?
What needs to be arranged once the pt is stable?
Which medications need to be stopped?
→ If the pt is on Warfarin, what is the protocol of management here?
➊ Fluid Resuscitation
→ Put the pt into Therapeutic Hypotension as you don’t want them to become overloaded
➋ • Supplementary O2
• NBM
➌ FBC, U&E, LFT, INR, G&S/Crossmatch
→ Urea is the product of protein breakdown and is excreted by the kidneys. Blood is like a “protein meal” in the gut, therefore urea is raised if digested.
➍ 2 large-bore cannulas
→ May be difficult in the arms due to the pt being peripherally shut-down, therefore the femoral is usually used. Internal jugular isn’t used as it’s collapsed, therefore increasing the risk of hitting the carotid instead.
➎Endoscopy
➏ Anticoagulants and NSAIDS
→ If raised INR and major GI bleed, stop the warfarin and give Cryoprecipitate first (as it works faster) and Vit K
What Scoring system is important to know of here?
→ What does it calculate?
Which risk factors does it take into account?
➊ Rockall Score
→ % risk of re-bleeding and overall mortality. It can be used pre/post-endoscopy and takes into account risk factors.
➋ • Age
• Haemodynamic instability
• Co-morbidities
• Cause of bleeding (e.g. Mallory-Weiss tear or Malignancy)
• Endoscopic findings (e.g. clots, bleeding vessels)
