Upper GI Bleeding

Question 1

What aspects are used in the Rockall Score for upper GI bleeding to predict mortality? (ASC)

Answer 1

Question 2

What aspects are invovled in the Glasgow Blatchford Score to predict need to intervention or death in upper GI bleeding? (BHHSO)

Answer 2

• Score > 0 indicates high risk

Question 3

Causes of upper GI bleeding

Answer 3

• Oesophageal varices
• Mallory-Weiss tear (tear of the oesophageal mucous membrane)
• Ulcers of the stomach or duodenum
• Cancers of the stomach or duodenum

Question 4

Presentation of upper GI bleeding

Answer 4

• Haematemesis
• Coffee ground vomit
• Malena
• Haemodynamic instability
• Epigastric pain and dyspepsia in gastric ulcers
• Jaundice for ascites in liver disease with oesophageal varices

Question 5

Management of upper GI bleeding (remember ABATED)

Answer 5

• ABCDE
• Bloods
  
  • Hb, urea, coagulation, platelets, liver disease, crossmatch
• Access
  
  • 2 large bore cannulas
• Transfuse
  
  • Depends on individual case
  • Transfuse once Hb <7-8g/Dl
  • Platelets if bleeding and count <50x10*9/L
  • Prothrombin complex concentrate for patients taking warfarin
• Endoscopy (for difinitive management)
  
  • Within 24hrs
  • Options include:
    
    • Adrenaline injection
    • Heater probe
    • Endoscopic clips
    • Thrombin, laser
    • Banding
    • Sengstaken-Blakemore tube
• Drugs
  
  • Stop anticoagulants and NSAIDs
  • IV PPIs reduce re-bleeding and mortality
  • For patients on aspirin continue low dose after haemostasis achieved
  • BBs or banding can be used for primary prophylaxis
  • Vasopressors early
  • Antibiotics early
• TIPS useful ‘rescue’ procedure for failed endo/drug therapy
• Surgical shunt/transection