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Flashcards in GI - Upper gastro bleeding Deck (4)
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What does melaena imply in terms of the origin of bleeding?

melaena implies the blood has undergone some digestive action and that the source is proximal to the ileocaecal valve

But torrential loss from an Upper-GI source may result in passage of bright-red blood per rectum


When Is the bleeding haemodynamically significant?

1)external evidence of blood loss, greater than 500ml

2)resting tachycardia: pulse ≥ 100 beats/min (patients on beta-blockers may not exhibit a tachycardia)

3)systolic blood pressure : ≤ 100 mmHg (BP of 110 may not be “normal” for elderly patients)

4)orthostatic hypotension : pulse increase of ≥ 20 beats/min or decrease in systolic pressure of ≥ 20 mmHg


Rx of Upper GI significant bleeding

1) A portal for transfusion must be established – two large-bore 16 to 18 gauge IV-cannula
2) A supply of blood must be obtained
3) An early, indeed urgent effort must be made to arrive at an anatomical diagnosis

Restoration of normovolaemia:
1) Rapid infusion of crystalloids
2) Transfusion of colloids - plasma substitutes
3) Packed cells and/or whole blood
4) Consider CVP monitoring
5) Urinary output monitoring with cathether


Common causes of upper GI bleeding

Peptic ulcer disease 45%
Oesophageal varices 15%
Gastro-duodenal erosions 10%
Mallory-Weiss tear 7%
Angioectasias 7%
Oesophagitis 5%
Upper GI-Tumour 5%
Gastropathy 2%
Large Hiatus Hernia 2%
Dieulafoy lesion 2%
Aorto-enteric fistula

Ask about: history of heavy drinking, known peptic ulcer with or without surgery; NSAID ingestion; chronic liver disease; abdominal aortic aneurysm; anti-coagulant medications

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