Upper GI bleeding

Question 1

What are causes of GI bleeds?

Answer 1

Varies, peptic ulcers, Mallory-Weiss tears, gastritis/duodenitis/oeophagitis, drugs (e.g. anticoagulants/platelets, NSAIDs), bleeding disorders, Boerhaave syndrome, malignancy

Question 2

What are Sx of UGIB?

Answer 2

melaena
haematemesis
coffee ground vomiting

tachycardia, hypotension, shock can occur with significant blood loss

Question 3

What are risk assessment tools in UGIB?

Answer 3

Rockall score: likelihood of bad prognosis

GBS: likelihood of needing an intervention

Question 4

What is initial management of UGIB?

Answer 4

Stop anticoagulants

2 large bore IV cannulae (take bloods here, groups and save, crossmatch)

IV fluids

Catheter

PRC if HB < 70

Correct any clotting abnormalities (may need FFP, vitamin K, platelets)

Endoscopy

Question 5

What additional Rx for suspected variceal bleeding?

Answer 5

Terlipressin

Antibiotics

Question 6

When should endoscopy be done?

Answer 6

If GBS = 0, discharge and do as outpatient

If GBS = 1, admit and do within 24 hours

If GBS 1, do urgently

Question 7

How are chronic bleeding ulcers treated at endoscopy?

Answer 7

Heat probe, haemoclips and 1 in 10,000 adrenline

Question 8

How are oesophageal varices treated at endoscopy?

Answer 8

Banding, sclerotherapy e.g. inject thrombin, and transjugular intrahepatic portosystemic shunt (TIPS) as rescue therapy

Question 9

How are gastric varices treated at endoscopy?

Answer 9

cyanoacrylate glue injection

Question 10

When is a Sengstaken tube used?

Answer 10

For uncontrolled variceal bleeding whislt waiting for endoscopy to control the bleeding. Inflate a balloon against the varices

Question 11

What are varices?

Answer 11

dilated collateral blood vessels that develop as a complication of portal hypertension, usually in the setting of cirrhosis.

Question 12

What are causes contributing to risk of portal hypertension?

Answer 12

Alcohol and hep B/C

Also: autoimmune liver disease, haemochromatosis, Wilson’s, Budd-Chiari syndrome

Question 13

What drugs can be given to patients with known portal hypertension to help prevent risk of varices?

Answer 13

non-selective beta blockers e.g. propranolol
terlipression

surveillance endoscopy can be done

varices should be banded before they bleed

Question 14

What treatment for high risk bleeding ulcers post endoscopy?

Answer 14

Hong Kong protocl: 72 hours IV PPI