Upper GI Bleeding Flashcards
Common causes
Peptic ulcers Mallory Weiss tear Oesophageal varies Gastritis/gastric erosion Drugs (NSAIDS, aspirin, steroids, thrombilytics, anticoagulant) Oesophagitis Duodenitis Malignancy No obvious cause
Rarer causes
Bleeding disorders Portal hypertensive gastropathy Aortic-enteric aneurysm Angiodysplasia Haemobilia Dieulafoy lesion Meckels diverticulum Peutz-jehgers syndrome Osler Weber rendu syndrome
Assess for a cause
Known morbidity Has it happened before Drugs taking Weight loss Dysphagia
Assess the prognosis
Comorbidities
Look at the signs
Chronic liver disease
Need to do a PR to checks for
Melaena
Are they in shock
Cool clammy
Low GCS
Tachycardia
Hypotension
What score should be calculated
Rockall score
What does the rockall score do
It risk scores to determine mortality and risk of a re bleed
Components of the rockall score
Pre endoscopy Age, shock, comorbidities Post endoscopy Diagnosis Signs of a recent haemorrhage
Define haematemesis
Vomiting blood
Can be fresh bright red
Or coffee ground
Define melaena
Black motions
Described at tar
Characteristic smell of altered blood
Treatment of a most important investigation to allow control of the bleed
Urgent endoscopy
If this fails
Surgery
Emergency mesenteric angiography embolisation
What is the treatment for uncontrollable varies
Seng staken blakemore tube that compresses varies this needs to be done by someone trained
What are gastric oesophageal varies
Submucosal dilatation 2ndary to inc portal pressure
May not have documented liver disease but suspect if alcohol history
