upper GI bleeds Flashcards
symtpoms
- haematemesis - vomitting blood
- melaena - black tarr stools
- epigastric dyscomfort
- collapse
- coffee ground vomitting
causes (5)
peptic ulcer most common - 50%
- oesophagitis
- mallory-weiss tear - oesophagus tear
- cancer
- variceal bleeding - bleeding from veins in oesophagus or stomach usually due to portal hypertension from hepatic cirrhosis
investigations
bloods:
- FBC - haem
- U&E - raised urea
- LFTs - liver cirrhosis
- endoscopy
- glasgow-blatchford and rockall scoring
- oesophagogastroduodenoscopy
management
non-variceal:
- adrenaline injection at bleeding site - vasoconstriction
- thermal and mechanical ligation - to close bleeding site
- proton pump inhibitors for 72 hours
variceal bleeding:
- terlipressin - vasocompressor for hepatic portal - lowers portal hypertension
- prophylactic antibiotics
- band ligation - to compress the veins to stop bleeding
risk factors (7)
- NSAID
- alcohol
- H. pylori
- Smoking
- Chronic liver disease
- Previous history of peptic ulcers
- Severe physical stress or critical illness
Glasgow-Blatchford score
- identify high risk patients for need for transfusion, intervention or death
- A score of 0 or 1 is the optimum threshold for identifying very low-risk patients suitable for outpatient management.
variceal vs non-variceal bleed presentation + action
variceal bleed:
- Suspect in patients with a history of liver disease or alcohol excess.
- Antibiotics and Terlipressin (reduces hepatic portal hypertension)
- Endoscopy within 24 hours.
Non-variceal bleed:
- Suspect in patients with a history of peptic ulcers, using certain medications; NSAIDs, anticoagulation or antiplatelets.
- Consider proton pump inhibitors.
- Endoscopy within 24 hours.
epidemiology
- common 50-70k admissions in uk yearly
- mortality 10%
- men more affected
- most common cause is peptic ulcer disease
signs (7)
Tachycardia
Hypotension
Prolonged capillary refill time
Altered mental state
Abdominal tenderness
Melaena or haematochezia (fresh red blood) on rectal examination
Stigmata of chronic liver disease in patients with cirrhosis, e.g.:
- Spider naevi
- Gynaecomastia
- Palmar erythema
- Caput medusae
Complications
- rebleeding
- pneumonitis
- death in 10%
Binge drinking alcohol
long periods of wretching
mallory-weiss tear
boerhaave syndrome - diffuse lung sounds also present
Secondary haemorrhage prophylaxis - oesophageal varicies - treatment
non-selective beta blockers
propranolol
most common biochemical finding
high urea
initial management if the patient is haemodynamically unstable and in shock
IV fluids
patients with gi bleeds can lose blood very quickly so must replace
what reverses the action of warfarin
prothrombin complex concentrate
rockfall poor outcome
metastatic prostage cancer
