Upper GI Haemorrhage

Question 1

Important points to take from history

Answer 1

Timing - onset/length
Colour
Other vomit?
Amount
NSAID use
Anti-coagulant use
Alcohol

Question 2

Emergency causes of upper GI bleeding

Answer 2

Oesphageal varices

Gastric ulcer

Question 3

Non-emergency causes of upper GI bleeding

Answer 3

Mallory-Weiss tear
Oesphagitis
Dieulafoy lesion

Question 4

What are oesphageal varices?

Answer 4

Dilatations of porto-systemic venous anastomoses. The dilated veins are thin so therefore rupture easily

Question 5

Causes of oesphageal varices

Answer 5

Portal hypertension due to cirrhosis caused by alcoholic liver disease

Question 6

Management of oesphageal varices

Answer 6

Band them
Inject adrenaline
Sengstaken-blakemore tube
Porto-systemic shunt

Question 7

What is gastric ulceration?

Answer 7

Erosion of blood vessels by ulcer

Question 8

Management of gastric ulcers

Answer 8

Gastroscopy
PPI therapy
Ulcer biopsy
Adrenaline injection
Cauterisation

Question 9

What is a Mallory-Weiss tear?

Answer 9

Tear in oesphageal epithelium, caused by repeated vomiting.

Most cases resolve themselves

Question 10

What is oesophagitis?

Answer 10

Inflammation of intraluminal epithelial layer, caused by GORD or Crohn’s

Question 11

What are Dieulafoy lesions?

Answer 11

Abnormally large veins - vascular malformation

Can cause bleeding

Question 12

What is used for prophylaxis of oesophageal bleeding?

Answer 12

Non-cardio selective B-blocker (propranolol)

Causes vasoconstriction