Upper GI bleeding Flashcards

1
Q

Common causes of Upper GI bleeding

A

Peptic ulcer disease (40%)
gastritis (20%)
Mallory-Weiss tear (10%)
Oesophageal varices (5%)

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2
Q

What is the Rockall score?

A

prediction of re-bleeding and mortality in patients with upper GI bleed

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3
Q

Initial Rockall score pre-endoscopy

A

age
shock (BP, pulse)
comorbidities

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4
Q

Final Rockall score post-endoscopy

A

active bleeding
visible vessel
adherent clot

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5
Q

Pathophysiology of oesphageal varices

A

Portal HTN → dilated veins at sites of porto-systemic
anastomosis: L. gastric and inferior oesophageal veins
30-50% with portal HTN will bleed from varices

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6
Q

Mortality rate of oesphageal varices

A

25% - ↑ with severity of liver disease.

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7
Q

Causes of portal HTN

A

pre-hepatic: portal vein thrombosis
hepatic: cirrhosis, schistosomiasis, sarcoidosis
post-hepatic - Budd-Chiari, RHF, constrict pericarditis

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8
Q

1st and 2nd line prevention of bleed in oesphageal varices

A

1st line: β-blockers, repeat endoscopic banding

2nd line: TIPSS

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9
Q

Transjugular Intrahepatic Porto-Systemic Shunt (TIPSS)

A
  • creates artificial channel between hepatic vein and
    portal vein → ↓ portal pressure.
  • Colapinto needle creates tract through liver parenchyma and
    maintained by placement of a stent.
  • Used prophylactically or acutely if endoscopic therapy
    fails to control variceal bleeding.
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10
Q

Overview of management of upper GI bleeding

A
1. Resuscitate
blood if remains shocked
2. variceal bleed management
3. maintenance
4. urgent endoscopy
5. post-endoscopy
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11
Q

Resuscitation of upper GI bleed patient

A
  1. head-down
  2. 100% O2
  3. IV crystalloid infusion up to 1L
  4. Bloods - FBC, U +Es (increase urea), LFTs, clotting, ABG, glucose
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12
Q

Medical management of variceal bleed

A
  1. terlipressin IV

2. prophylactic Abx (e.g. ciprofloxacin)

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13
Q

Options for initiating haemostasis of a vessel or an ulcer via endoscopy

A
  1. adrenaline injection
  2. thermal/laser coagulation
  3. fibrin glue
  4. endoclips
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14
Q

Varceal bleeding management via endoscopy

A

I. 2 of:
1. banding,
2. sclerotherpay (injecting salt into vessel, causing its collapse)
3. adrenaline,
4. coagulation
II. balloon tamponade with Sengstaken-Blakemore tube
III. TIPSS if bleeding can’t be stopped endoscopically

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15
Q

Post endoscopy management of upper GI bleeding

A
  1. omeprazole
  2. keep NBM for 24h
  3. daily bloods
  4. H.pylori testing
  5. stop NSAIDs, steroids etc.
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16
Q

Indications for surgery of upper GI bleeding

A
  1. re-bleeding
    bleeding despite transfusing 6 units
  2. uncontrollable bleeding at endoscopy
  3. initial Rockall score ≥3, or final >6.