Upper GI Bleeds Flashcards
What is the forrest classification for?
Risk of rebleeding in upper GI lesions
III is lowest risk
Ia is higest risk
What are some causes of upper GI bleeds?
Peptic ulcer (30-50%)
Oesophageal/Gastric varices (20%)
Mallory Weiss Tears (15-20%)
Gastritis/Duodenitis (10-15%)
Oesophagitis (5-10%)
AV Malformations (5%)
Tumours (2%)
What is haemobilia?
Bleeding from the liver through the biliary tree
How are Mallory Weiss tears managed?
Typically self resolving
Consider PPI to reduce acid in oesophagus
Which beta blocker is used in portal hypertension?
Propranolol
What is the best sign of haemodynamic shock?
Tachycardia in young people
Hypotension in old people
What does terlipressin do?
Reduces portal pressure
What is haemosuccus pancreaticus?
Bleeding from the pancreas through the pancreatic duct
Where is exactly is upper GI bleeds?
Any bleeding above the ligament of Treitz (at the junction between the duodenum and jejunum)
Why do people with chronic liver disease die of GI bleeds?
Decompensation of their disease after the bleed and high protein load of the blood
Which pharmaceutical agent do you give every one with an upper GI bleed?
PPI - 80mg stat and 80mg infusion over 8 hours
Pantoprazole or esomeprazole or omeprazole
What is the balloon used to occlude oesophageal varices bleeds?
Sengstaken Blakemore tube
What are some risk factors for peptic ulcers?
H. pylori
NSAIDs
Smoking
EtOH
Psychological/Physiological stress
Gastrinomas
Which blood tests are useful in bleeds?
FBE
ABG/VBG
UEC
LFT
Coags
Cross match
What options are there for therapies when a bleed is seen on endoscopy?
Inject 10ml of adrenal in 4 places around the ulcer
Clip the vessel
Gold probe to cauterise
