Upper GI Bleeds and Varices Flashcards
What is haematemesis?
Vomiting blood
What is malaena?
Black, sticky faeces
What are common causes of upper GI bleeds?
Mallory-Weiss Tear Peptic ulcer Gastritis/Gastric erosion Drugs Oesophagitis Duodenitis Malignancy Idiopathic
What are drug examples that can cause upper GI bleeds?
NSAIDs Aspirin Steroids Thrombolytics Anticoagulants
The Blatchford Scoring system incorporates which factors for upper GI bleeds??
Hb Urea Systolic BP Sex Maelena Recent syncope Hx of Hepatic disease Hx of Heart failure
How do you manage an upper GI bleed?
Resuscitation
Organise CXR, ECG and check ABG
Correct anything to make haemodynamically stable
Omeprazole
Urgent endoscopy, acid suppression, interventional radiology, surgery
What does resuscitation in an upper GI bleed entail?
2 large-bore IV cannulas and take blood (FBC, U&E, LFT, clotting, crossmatch 4-6 units)
IV fluids - O neg blood if emergency until cross match
Organise CXR, ECG and check ABG
Consider CVP line to monitor and guide fluid replacement
Transfuse (with cross-match) until stable
Correct clotting abnormalitites
Monitor pulse, BP and CVP at least hourly until stable
What is the endoscopic procedure used for upper GI bleeds?
Inject adrenaline Heater probe coagulation Combination of above Clips (2-3) Haemospray
Why do you inject adrenaline during endoscopy of upper GI bleeds?
Causes vasoconstriction, physical tamponade and pressure around vessels –> haemostasis
What is the purpose of heater probe coagulation during upper GI bleeds?
Cauterise - stabilise
What is the mechanism of haemospray?
Powder absorbs water then acts co-adhesively to form mechanical barrier over bleeding site
What are varicose?
Thin-walled fragiel veins in the oesophageal walls
Rupture of varicose is?
A medical emergency
What causes dilated collateral veins (varices)?
Portal hypertension
Where are varices found?
Lower oesophageal, rectal and umbilical region
