Upper GI Bleeding Flashcards
what is the most common cause of upper GI bleeding?
Duodenal ucler, gastric erosions or gastric ulcer
what is the treatment of bleeding peptic ulcers?
- endoscopic treatment
- acid suppression
- surgery
what is the endoscopic treatment of peptic ulcers?
- injection (adrenaline 1:10000)
- heater probe coagulation
- combinations
- clips
- haemospray
how does hemospray work?
when it comes into contact with the blood, the powder absorbs water, then acts both cohesively and adhesively, forming a mechanical barrier over the bleeding site
what would you use for acid suppression?
intravenous omeprazole (PPI)
when would you suspect a variceal bleed?
- known history or cirrhosis
- history of alcohol excess, hepatitis, autoimmune liver disease, sepsis
signs of variceal bleed
- spider naevi
- palmar erythema
- leukonchia
- encephalopathy
- ascites
- jaundice
what intial considerations would you take if a GI bleed was suspected?
- coagulopaty (FFP/platelets/Vitamin K)
- CVP monitoring
- parenteral vitamins
- antibiotics
- hypoglucaemia
- replace K+, Mg2+ and PO4
how would you achieve haemostatis?
- Terlipressin (vasopressin analogue)
- Endoscopic variceal ligation (banding)
- Scelortherapy
- Sengstaken-blakemore balloon
- TIPS
what is terlipressin?
- vasopressin prodrug
- ease of use: bolus 1-2mg 4 hrly
- predominantly splanchnic vasoconstrictor
- beneficial effect on renal perfusion
what is sclerotherapy?
injection of drug into veins to shrink them
