Upper GI bleeding

Question 1

Diagnostic Signs of Upper GI bleed?

Answer 1

Melaena (black, tarry stools) OR Haematemesis (vomiting blood)

Question 2

Other common signs?

Answer 2

Cause dependent:

Abdominal pain, tenderness, pallor, heartburn, dyspepsia.

Question 3

Investigations for Upper GI bleed?

Answer 3

1) Basic Vital Function: Obs, urine output, ECG, Bloods
2) Upper GI Endoscopy (<24h presentation)
3) CXR - perforation e.g. Pneumomediastinum, free gas

Question 4

Acute management for Upper GI bleed?

Answer 4

1) ABCDE
2) Major Haemorrhage protocol = resuscitation
3) Repeat endoscopy

Question 5

Longer term management of Non-variceal bleeds?

Answer 5

1) ADRENALINE
2) Repeat endoscopy
3) Re-bleed = surgical intervention

Question 6

Medical management of Variceal bleeds?

Answer 6

1) IV Terlipressin

2) Antibiotics - SBP prevention

Question 7

Endoscopic Management of Variceal Bleeds?

Answer 7

Variceal Band ligation (every 2-4 weeks).