Upper GI bleeds Flashcards
Name 4 causes of an upper GI bleed
- Ruptured oesophageal varices
- Mallory-Weiss tear
- Ulcers of the stomach or duodenum
- Cancers of the stomach or duodenum
- Gastritis or gastric erosions
- Drugs i.e. NSAIDs, aspirin, steroids
What is a Mallory-Weiss tear?
A tear of the oesophageal mucous membrane
Name 3 ways an upper GI bleed can present
- Haematemesis
- Melaena
- Symptoms related to the underlying pathology i.e. jaundice, epigastric pain
- Haemodynamic instability in severe blood loss (low blood pressure, tachycardia and other signs of shock)
- Raised urea
1) What is the Glasgow-Blatchford score?
2) What is the Rockall score?
1) Scoring system to predict the need for treating someone that presents with an upper GI bleed
2) Score used for patients that have had an endoscopy to calculate severity, their risk of rebleeding and overall mortality
What is the management of upper GI bleeds (ABATED)?
A – ABCDE approach to immediate resuscitation
B – Bloods
A – Access (ideally 2 large bore cannula)
T – Transfuse
E – Endoscopy (arrange urgent endoscopy within 24 hours)
D – Drugs (stop anticoagulants and NSAIDs)
1) In the management of uncontrollable variceal haemorrhaging, the first priority is to stop further bleeding - what drug is given first to achieve this?
2) If this drug doesn’t work, what tube is inserted?
3) Once the bleeding has been controlled, what is the 1st line management for oesophageal varices?
4) What is the definitive management of oesophageal varices?
1) IV terlipressin (vasoactive substance)
2) Sengstaken-Blakemore tube
3) Endoscopic variceal ligation
4) Transjugular intrahepatic porto-systemic shunt (TIPSS)
What is the main side effect of the TIPSS procedure?
Worsen or cause hepatic encephalopathy
What drug can be given as prophylaxis for a variceal bleed?
Beta blocker
What is the anatomical definition of an upper GI bleed?
Haemorrhage with an origin proximal to the ligament of Treitz - found at the duodenojejunal flexure
