Upper GI bleeding

Question 1

Name some causes of peptic ulcers

Answer 1

o Acid
o H. pylori
o NSAIDs

Question 2

what scoring system is used to assess a person’s mortality from a potential upper GI bleed

Answer 2

Glasgow Blatchford score. Score predicts the mortality of an upper GI bleed

Question 3

what factors does the blatchford score use

Answer 3

urea, haemoglobin, BP, pulse, presentation with any dangerous signs e.g. melena

Question 4

name a therapy you give post endoscopy to reduce the risk of rebleed and reduce mortality

Answer 4

PPI

Question 5

what is a varice

Answer 5

These are submucosal venous dilatations that are secondary to increased portal pressure, usually due to cirrhosis of the liver.
Collateral formation is ket to this. Primary blood vessels of concern are those in the lower oesophagus.

Question 6

how are varices treated

Answer 6

endoscopic banding, TIPS (last resort), beta blockers (vasodilation, reduction in portal pressure)

Question 7

how should acute variceal bleeding be managed

Answer 7

• Acute bleeding
– Antibiotics & Terlipressin (in A&E)
– Banding first line for oesophageal variceal bleeding
– Tissue glue injection for gastric variceal bleeding
– TIPS for uncontrolled variceal bleeding
– Balloon tamponade (as temporary salvage)