Upper GI bleeds Flashcards
Describe two obvious characteristics of upper GI bleeding?
- Haematemesis
- Vomiting blood: red or coffee ground
- Melaena
- Black bowel motions
Causes of upper GI bleeding?
From most to least common
- Peptic ulcer
- Gastric erosions
- Oesophagitis
- Mallory-Weiss tear (retching)
- Varices
Drug causes of upper GI bleeding?
- NSAIDs
- Aspirin
- Steroids
- Thrombolytics
- Anticoagulants
SATAN*
Describe a risk score for upper GI bleeds?
Rockall risk-score
What invesitgation should be performed urgently for someone with upper GI bleeding?
Endoscopy
Describe the management of high-risk peptic ulcer bleeds based on endoscopic findings?
- Active bleeding, adherent clot or non-bleeding visible vessel
- Achieve endoscopic haemostasis
- 2 of:
- Clips
- Cautery
- Adrenaline
- 2 of:
- Start PPI
- If haemodynamically stable: Oral intake of clear liquids 6h post endoscopy
- Treat H. pylori if positive
Describe the management of low-risk peptic ulcer bleeds based on endoscopic findings?
- Flat, pigmented spot or clean base
- No need for endoscopic haemostasis
- Consider early discharge
- Give oral PPI
- Regular diet 6h post endoscopy
- Treat H pylori if positive
Most common cause of upper GI bleeds?
Peptic ulcer disease
Important aspects of a history of someone with upper GI bleeding?
- Previous bleeds
- Dyspepsia, known ulcers
- Liver disease or oesophageal varices
- Dysphagia, weight loss
- Drugs
- Co-morbidities
Management of upper GI bleeding?
What do haematemsis and coffee ground vomiting indicate respectively?
- Haematemesis
- Red with closts
- Bleeding is rapid and profuse
- Coffee ground vomiting
- Black
- Bleeding is less profuse
Describe malaena?
- Passage of black, tarry stools
- Usually from upper GI bleeding
- Also haemorrhage of right colon
- Colour and smell are due to action of digestive enzymes and bacteria on Hb
Describe the steps involved in the emergency management of upper GI bleeding?
Non-variceal bleeding **
- IV access
- Clinical assessment
- Basic investigations
- Resuscitation
- Oxygen
- Endoscopy
- Monitoring
- Surgery
- Eradication
Describe the initial clinical assessment of someone with upper GI bleeding
- Define circulatory status
- Severe bleeding causes tachycardia, hypotension, oligiuria
- Seek evidence of liver disease
- Decompensated cirrhosis: jaundice, hepatosplenomegaly, ascites
- Identify comorbidity
- CV, respiratory or renal disease can be worsened by acute bleeding
- Glasgow blatchford score
Describe the interpretation of a Glasgow Blatchford Score?
- Score of 2 or less: good prognosis
- Increasing scores thereafter = worse prognosis
What basic investigations should be performed for someone with acute upper GI bleeding?
- FBC
- Anaemia
- May be normal after sudden bleeding until haemodilution occurs
- U&Es
- Evidence of renal failure
- Elevated urea with normal creatinine implies severe bleeding
- LFTs, PT, Cross-match 2 units of blood
Describe the resuscitation of someone with acute upper GI bleeding?
- IV crystalloid fluids to raise BP
- Saline
- Should be transfused when patient is actively bleeding with low BP and tachycardia
Describe the endscopy for upper GI bleeding?
- Within 24 hours after resuscitation
- Can perform treatments:
- Heater probe
- Endoscopic clips + adrenaline injection
- Patients bleeding from varices:
- Band ligation
- TIPSS
- PPI should not be given before endoscopy as it can mask the site of bleeding
Describe eradication therapy for those who have had an upper GI bleed from ulcers?
- Avoid NSAIDs
- H. pylori positive patients receive eradication
- Confirmed by:
- Urea breath test
- Faecal antigen testing
- Confirmed by:
Name a specific treatment for someone with GI bleeding and cirrhosis
- Broad spectrum antibiotics due to sepsis risk
- Oral Ciprofloxcin
- or IV cephalosporin
Describe the different drugs used in eradication therapy?
- Omeprazole
- Amoxicillin
- Metronidazole
What blood test allows you to differentiate between an upper and lower GI bleed?
- U&Es
- Elevated urea
- Normal creatinine
