Upper GI Bleeding Flashcards
what are the top three causes of upper gi bleeds
peptic ulcers, oesophagitis, no obvious cause
what are all the usual causes of upper gi bleeding
Mallory-Weiss tear • Oesophagitis/Gastritis • Oesophageal varices • Peptic ulcer • Malignancy • Drugs – NSAIDs, aspirin, anticoagulants, steroids • Angiodysplasia • Aorto-enteric fistula
to treat upper gi bleed what do you have to consider
check if any medication patient is on should be stopped, do they need blood transfusions, what is the clotting profile of their blood, do they need a platelet transfusion, antibiotics need
when would you need to consider giving antibiotics to patient with upper gi bleed
Consider antibiotics if risk of
aspiration or varices, signs of onfection
when transfusing patients which strategy is better and why liberal or restrictive
restrictive waits until hb has gone to minimal level not just because it will probably help. if too much blood is given can lead to poor outcomes for those with comorbidities e.g heart failure
how would you treat upper gi bleed of variceal nature
Terlipressin • Analogue of vasopressin. Causes vasoconstriction. Caution in IHD/PVD • 2mg IV QDS (usually 72hrs max) – Antibiotics (Co-amoxiclav 1.2g IV TDS)
how would you treat non variceal upper gi bleed
proton pump inhibitors Pantoprazole infusion
what is the purpose of the blatchford score
Aim to identify patients that require clinical
intervention (blood transfusion/OGD
therapy)
patient with upper gi bleed has a blatchford score of 6 what does this mean
urgent ogd is needed, airway needs to be protected, give patient iv erythromycin 30 mins before procedure
after carrying out ogd on patient what do I do in the followup
continue ppi, terlipressin, antibiotics as advised, do a rockall score, clear fluids after one hour, light diet after 6 hours, monitor for sign sof re bleeding, you may have to repeat ogd or inform IR surgeons
what is rockall score
Aim to identify risk factors to predict
mortality and risk of rebleeding
• Requires OGD findings for full score
• Does not assess need for clinical intervention
or predict those for out patient management
what does rockall score take into account and what does a score of less than 3 vs greater than 8 suggest
less than 3 good prognosis, above 8 risk of mortality is high, accounts for age shock comorbidities diagnosis recent haemorrhages
what can cause peptic ulcers
nsaid drugs e.g ibuprofen, h pylori hypersecretory
Gastrinoma
what lifestyle choice should people with peptic ulcers be advised on
to stop smoking
how can you diagnose helicobacter pylori
stool antigen, urea breath test, it is prevalent in half the populations and does not cause symptoms in 80 percent
