Management of Upper GI Bleeding Flashcards
common causes
duodenal/gastric ulcers
duodentis
oesophagitis
malignancy
drugs
rare causes
bleeding disorders
portal hypertensive gastropathy
dieulafoy lesion
causes
ulcers
haemorrhagic gastropathy
reflux oesophagitis
gastric carcinoma (cancer)
varices
signs of liver disease
jaundice
edema
palmar erythma
heavy drinker
intial managements
oxygen
fluids
bloods
transfusion/clotting
PPIs
endoscopy
urinary catheter (monitoring)
definitive management
endoscopy diagnosis (site/cause/risk)
depends on patient
check with rockall score - those whom are older, sicker, more shocked and active bleeders will have higher score
gastric/duodenal ulcers
imbalance of acid secretion/pepsin/mucosal defence
cause by- helicobacter pylori, drugs, smoking, alcohol, stress
signs- heamatemesis, melaena, dyspepsia, abdominal pain, acid reflux
difference between gastric and duodenal ulcers
gastric- initiated soon after eating, relieved by vomiting, aggravated by eating
duodenal - initiated 2-3 hrs after eating, relieved by eating, aggravated by stress/ missing a meal
endoscopic treatement of ulcers
inject adrenaline, sclerosants, fibrin glue
clipping
thermal electrocoagulation, argon plasma laser
when to give surgery
need OGD to identify site
rebleeding after endoscopy
uncontrolled bleeding/shock
mallory weiss tears
tear on gastric side of gatroesophageal junction
can be caused by high intragastric pressure
symptoms- vomiting/retching, blunt trauma, straining
most stop on their own but some require endoscopy and clipping
oesophageal varices
dilation of subepithelial/muscoral veins
increased portal pressure
portal systemic shunting
damage between portal and systemic venous system
treatment- ABC, sclerotherapy, banding, sengstaken tube
