GI: Upper GI bleeds, haematemesis and malaena

Question 2

What are the causes of an upper GI bleed?

Answer 2

Oesophageal varices
Mallory-Weiss tear
Peptic ulcers
Cancers of stomach or duodenum

Question 3

A patient presents with a GI bleed, what do you need to ascertain from their PMH?

Answer 3

Hx of varices or chronic liver disease
Any stigmata of (chronic) liver disease
use of :NSAIDs,Anti-platelets,Anti-coagulants

Question 4

What are the 2 scoring systems used in GI bleeding and what do they score?

Answer 4

Rockall- for patients that have or are going to have endoscopy, their risk of dying

Blatchford- establishes the risk of patient who you ?GI bleed is a GI bleed, used to determine whether should intervene

Question 5

What parameters does the Blatchford score take into account?

Answer 5

Drop in Hb
Rise in Urea
Blood pressure
Heart rate
Malaena
Syncope

Question 6

What do you need to establish if a patient has a GI bleed?

Answer 6

Is it variceal?

Question 7

What is the initial management for patients with GI bleeding

Answer 7

Used mneumonic ABATED
A- A-E assessment
B- Bloods
A-Access- IV access - if pt haemodynamically compromised, resus fluids and then transfuse
T- Transfuse
E- Endoscopy
D- Drugs, stop any NSAIDs or Anticoagulants

Question 8

What bloods do you need to do for a patient with GI bleeding and WHY?

Answer 8

FBC and Platelets- Check if Hb is dropping and thrombocytopenia can indicate chronic liver disease. Platelets need to be replaced if lost

U&Es- rising urea supports diagnosis of GI bleed

LFTs- check liver function, may show impaired function/liver disease

VBG- quick Hb reading

Coag screening - are they bleeding due to a clotting disorder?

Crossmatch/group and save- crossmatch if patient is haemodynamically unstable

Question 9

You have started initial management for a patient with GI bleeding, the cause of this is suspected ruptured varices, what additional steps would you add in your management?

Answer 9

IV terlipressin
IV broad spec antibiotics

Endoscopic banding to stop the bleeding
If this fails- Linton tube or TIPSS (trans jugular intrahepatic porto systemic shunt)

Question 10

What is the most common cause of non-variceal GI bleeding?

Answer 10

Peptic ulcer disease

Question 11

What is dieulafoys?

Answer 11

An abnormally large artery in the lining of GI tract, most commonly the stomach

Question 12

How would a patient present with peptic ulcer disease?

Answer 12

Epigastric pain
Dyspepsia
Nausea and vomitting
Bleeding- malaena, coffee ground vomit or haematemesis
Iron deficiency anaemia

If duodenal ulcer (more common) = have epigastric pain when hungry, relieved by eating.
If gastric ulcer = epigastric pain worsened by eating

Question 13

How would you treat a patient that presents with peptic ulcer disease?

Answer 13

If actively bleeding see ABATED mnemonic in Z2F

Rapid urease test to check for H.pylori- treat with amoxicillin and clarithromycin for 7 days +PPI
PPIs is the mainstay of treatment

Question 14

What the complications of peptic ulcer disease?

Answer 14

Bleeding
Perforation leading to acute abdomen and/or peritonitis
Scarring/ strictures leading to pyloric stenosis

Question 15

What are some risk factors for variceal haemorrhage?

Answer 15

High portal pressures (>12mmHg)
Large varices
Abnormal variceal wall at endoscopy (eg haematocystic spots)
High Child-Pugh score

Question 16

How do you differentiate between an upper GI bleed vs lower GI bleed based on blood results?

Answer 16

Upper GI bleed more likely to have high urea