Upper GI Bleeding

Question 1

How does upper GI bleeding present? (3)

Answer 1

Haematemesis
Coffee ground vomiting
Melaena

Question 2

List 4 common causes of upper GI bleeding.

Answer 2

Peptic ulcer
Oesophagitis
Gastritis
Duodenitis

Question 3

List 3 causes of peptic ulcers.

Answer 3

Increased acid production
H. pylori
NSAIDs

Question 4

List 4 more uncommon causes of upper GI bleeding.

Answer 4

Oesophageal varices
Malignancy
Mallory-Weiss tear
Other

Question 5

What is a mallory-weiss tear?

Answer 5

Tear in the oesophageal lining

Question 6

What is the immediate management of an upper GI bleed? (5)

Answer 6

Resuscitate 
Risk assessment
Drug therapy
Blood transfusion
Endoscopy

Question 7

What type of resuscitation is needed for upper GI bleed? (3)

Answer 7

IV access
Give oxygen
Lie flat

Question 8

What 3 scoring systems are used for upper GI system?

Answer 8

Rockall score
Glasgow Blatchford score (GBS)
AIMS 65

Question 9

How do you measure the Rockall score for upper GI bleed?

Answer 9

AGE:
<60: 0 points
60-79: 1 point
80+: 2 points

SHOCK:
No shock: 0 points
Tachycardia: 1 point
Hypotension: 2 points

COMORBIDITIES:
None: 0 points
IHD, HF: 2 points
Renal failure, liver failure, metastatic malignancy: 3 points

Question 10

According to the Glasgow Blatchford score (GBS), how do you classify low risk upper GI bleed? (5)

What score would this be?

Answer 10

GBS 0

Urea: <6.5
Hb: 130+ (men), 120+ (women)
Systolic BP: 110+
Pulse: <100

Absence of other features, including:

• Malaena
• Syncope
• Chronic heart failure
• Liver disease

Question 11

What is the clinical significance of the Glasgow Blatchford score?

Answer 11

GBS 0 indicates outpatient treatment

Question 12

How would you determine when to do an endoscopy? (3)

Answer 12

High risk: emergency endoscopy
Moderate risk: admit, then next day endoscopy
Low risk: outpatient treatment

Question 13

Which drugs would you give for upper GI bleed?

What are their effects?

How long for?

Answer 13

IV proton pump inhibitors

Reduces re-bleeding risk

Duration: 72 hours

Question 14

In upper GI bleed, what would you do for:

a) Patients on NSAIDs
b) Patients on aspirin
c) Patients on clopidogrel
d) Patients on warfarin

Answer 14

Stop NSAIDs

Continue low dose aspirin

Discuss clopidogrel/warfarin with specialist after haemostasis achieved

Question 15

Which 4 different blood products can you give for upper GI bleed?

When would you give each of these?

Answer 15

Transfusion, if:
-Hb <7-8

Platelets, if:

• Active bleeding
• Platelet count <50

Fresh frozen plasma (FFP), if:
-INR 1.5+

Prothrombin complex concentrate, if:

• Active bleeding
• On warfarin

Question 16

On endoscopy, the appearance of ulcers determines re-bleeding risk. In order of highest risk to lowest, which features can be seen? (5)

Answer 16

Active bleeding
Non-bleeding visible vessels
Blood clots
Dots
Clean base

Question 17

Which treatments can be done via endoscopy? (5)

Answer 17

Adrenaline injection
Cautery of a duodenal ulcer
Endoscopic clips
Thrombin
Laser treatment

Question 18

How would you treat acute variceal bleeding? (5)

Answer 18

Antibiotics
Terlipressin
Endoscopic banding
TIPS
Balloon tamponade

Question 19

What is TIPS?

Answer 19

Transjugular intrahepatic portosystemic shunt

Question 20

Which drug would you use to prevent variceal bleeding/re-bleeding?

Answer 20

Beta blockers