Upper GI bleeding

Question 1

What is melaena?

Answer 1

Black/dark, tarry faeces, associated with upper GI bleeding.
Often accompanied by strong odour due to haemoglobin being altered by digestive enzymes and intestinal bacteria.

Question 2

What is haematemesis?

Answer 2

Vomiting blood

Question 3

What are the most common causes of melaena?

Answer 3

Peptic ulcers (most common)
Oesophageal varices

Question 4

What is used to stratify patients with upper GI bleeding into risk of death?

Answer 4

Glasgow-Blatchford score

Question 5

What factors are considered in the Glasgow-Blatchford score?

Answer 5

Systolic blood pressure
Blood urea
Haemoglobin
Symptoms (pulse, melaena, syncope, hepatic disease, cardiac failure)

Question 6

What important thing should you remember when managing patient with upper GI bleeding?

Answer 6

ABCDE
Airway
Breathing
Circulation
Disability
Exposure

Question 7

What should you suspect in patients with a history of liver disease or alcohol excess and upper GI bleeding?

Answer 7

Variceal bleeding

Question 8

How do you manage a variceal bleed?

Answer 8

Antibiotic (prevent sepsis from bacteria from GI tract into bloodstream) and Terlipressin (causes splanchnic vasoconstriction to reduce pressure, slows down bleeding).

Urgent endoscopy within 24 hours.

Question 9

What should you suspect in patients with a history of peptic ulcers or using NSAIDS, anticoagulants or antiplatelets with upper GI bleeding?

Answer 9

Non-variceal bleed

Question 10

How do you manage a non-variceal bleed?

Answer 10

Consider proton pump inhibitors
Urgent endoscopy within 24 hours