Upper GI bleeding

Question 1

Malaena =

Answer 1

more than 400ml of blood
black stool
distinct smell - differentiates from Fe tablets/medication causes of black stool

Question 2

Arterial bleeds are treated by (3)

Answer 2

injection (adrenaline)
heater probe
clips to ligate

Question 3

Treatment of angiodysplasia (small red bleeds)

Answer 3

argon plasma coagulation

RF ablation

Question 4

Endoscopy is contraindicated in -

Answer 4

recent infarct
anticoagulation therapy/ bleeding diathesis
infection risk

Question 5

4 main causes of upper GI bleeding commonest to least common

Answer 5

duodenal ulcer
gastric erosions
gastric ulcer
varices

Question 6

Initial management of all upper GI bleeds

Answer 6

resuscitation
airway protection
O2
IV access (2 large bore grey cannula in antecubital fossa)
fluids

Question 7

Risk scores for severity of upper GI bleed

Answer 7

Rockall - pre and ost endoscopy

Blatchford - pre endoscopy stratifies and shows urgency of endoscopy

Question 8

___ is used to identify cause of and treat upper GI bleeds

Answer 8

Endoscopy

Question 9

Stigmata of recent upper GI bleed =

Answer 9

active bleeding/oozing
overlying clot
visible vessel (nipple sign - fibrin clot on small clot)

Question 10

Treatment for ulcer bleed

Answer 10

endoscopy (2 attempts at most) =
inject adrenaline and heater probe coagulation together = 1st line
clip
haemospray - bridge 
IV omeprazole for acid suppression

Question 11

Treatment of variceal bleeding

Answer 11

terlipressin = splanchnic vasoconstrictor and good for renal perfusion
endoscopic ligation
sclerotherapy
Sengstaken-Blakemore tube - balloon tamponade
TIPS if all else fails