upper GI bleeding

Question 1

what are the causes of an upper GI bleed?

Answer 1

• Oesophageal varices
• Mallory-Weiss tear, which is a tear of the oesophageal mucous membrane
• Ulcers of the stomach or duodenum
• Cancers of the stomach or duodenum

Question 2

what are the different presentations for an upper GI bleed?

Answer 2

• haematemisis- vomiting blood
• coffee ground vomit
• melena

Question 3

what is the scoring system used in upper GI bleeds?

Answer 3

Glasgow-Blatchford Score

• a score based on clinical presentation
• establishes the risk of having an upper GI bleed and helps in discharge planning
• a score over >0 indicates a high risk

Question 4

what are the components of the Glasgow Blatchford score?

Answer 4

Drop in Hb

Rise in urea-> blood gets broken down in the GI tract and one of the breakdown products is urea

Blood pressure

Heart rate

Melaena

Syncopy

Question 5

what is the rockall score?

Answer 5

• provides a percentage risk of rebreeding and mortality for patients who have had an endoscopy

Question 6

what are the components of the rockall score?

Answer 6

Age

Features of shock (e.g. tachycardia or hypotension)

Co-morbidities

Cause of bleeding (e.g. Mallory-Weiss tear or malignancy)

Endoscopic stigmata of recent haemorrhage such as clots or visible bleeding vessels

Question 7

which bloods should you request in case of an upper GI bleed?

Answer 7

Haemoglobin (FBC)
Urea (U&Es)
Coagulation (INR, FBC for platelets)
Liver disease (LFTs)
group and save 
Crossmatch 2 units of blood

Question 8

what is the management for an upper GI bleed?

Answer 8

A – ABCDE approach to immediate resuscitation
B – Bloods
A – Access (ideally 2 large bore cannula)
T – Transfuse
E – Endoscopy (arrange urgent endoscopy within 24 hours)
D – Drugs (stop anticoagulants and NSAIDs)

Question 9

when to do a platelet transfusion?

Answer 9

when the platelet count is below 50 and there is ongoing active bleeding.

Question 10

what is borhaves?

Answer 10

oesophageal rupture . caused by vomiting against a closed glottis- presents with tacklers triad:

• vomiting
• chest pain
• subcutaneous emphysema

other sxs

• painful swallow
• tachypnoea
• dyspnoea

no blood, don’t know why I put the card here

Question 11

what are the X-ray findings for borhaves?

Answer 11

• pneumomediastinum
• left pleural effusion
• left pneumothorax
• CT scan can confirm diagnosis

Question 12

what is the treatment of borhaves?

Answer 12

• resus
• broad spectrum antibiotics
• endoscopic repair

Question 13

what should be administered before endoscopy for bleeding varicies?

Answer 13

Terlipressin + IV antibiotic

Question 14

what are the landmarks of an upper GI bleed?

Answer 14

The definition of an Upper GI Bleed is a haemorrhage with an origin proximal to the ligament of Treitz