Upper GI Bleeds

Question 1

Where is a bleed from in an upper GI bleed?

Answer 1

• Oesophagus
• Stomach
• Duodenum

Question 2

What can cause an upper GI bleed?

Answer 2

• Oesophageal varices
• Mallory-Weiss tear
• Peptic ulcers
• Stomach or duodenal cancer

Question 3

What is a Mallory-Weiss tear?

Answer 3

Tear of the oesophageal mucous membrane

Often caused by persistent vomiting
o Alcohol intoxication
o Self-induced vomiting
o Pregnancy

Question 4

What could an upper GI bleed present with?

Answer 4

• Haematemesis
• Coffee ground vomit
• Melaena
• Iron-deficiency anaemia
• Haemodynamic instability

Question 5

Which risk assessment tool do you use first?

Answer 5

Glasgow-Blatchford risk score (GBS)

Question 6

What does the Glasgow-Blatchford risk score (GBS) look at?

Answer 6

• Urea
• Hb
• Systolic BP
• Pulse
• Melaena
• Syncope
• Hepatic disease
• Cardiac failure

Question 7

Why does urea rise in a GI bleed?

Answer 7

Blood in GI tract is broken down by acid and digestive enzymes.
One of the breakdown products is urea

Question 8

When do you do the Rockall score (RS)?

Answer 8

After endoscopy

• Score <3 carries a good prognosis

Question 9

How do you manage an acute upper GI bleed?

Answer 9

ABATED
•	A - ABCDE approach
•	B - Bloods
o	H - Hb (FBC)
o	U - Urea (U+Es)
o	C - Coagulation (INR, FBC for platelets)
o	L - Liver disease (LFTs)
o	C - Crossmatch 2 units of blood
•	A - Access (2 large cannulas)
•	T - Transfuse
•	E - Endoscopy (within 24hrs)
•	D - Drugs (stop anticoagulants and NSAIDs)

Question 10

Which medications are linked with the formation of peptic ulcers or GI bleeds?

Answer 10

• Potassium channel activators – Nicorandil
• Antiplatelets
• Anticoagulants
• NSAIDs
• SSRIs
• Corticosteroids

Question 11

What do potassium channel activators (Nicorandil) increase the risk of?

Answer 11

GI ulceration