Outline risk assessment in patients with acute upper GI bleeding

Question 1

Outline risk assessment in patients with acute upper GI bleeding

Answer 1

1-Initial Clinical Assessment
A-Vital signs: Assess for hypotension, tachycardia, signs of shock.
B-History:
*Hematemesis, melena, hematochezia
*NSAID use, anticoagulants, alcohol
*Liver disease or prior GI bleeding
C- Physical exam:
*Signs of chronic liver disease (e.g., jaundice, ascites)
*Abdominal tenderness
*Rectal exam to confirm melena

Question 2

Outline risk assessment in patients with acute upper GI bleeding

Answer 2

2-Laboratory Tests
*Hemoglobin and hematocrit: To assess severity of blood loss.
*Urea: Often elevated in upper GI bleeding.
*Coagulation profile: INR/PT, especially in liver disease or anticoagulated patients.
*Liver function tests: Evaluate for cirrhosis.
*Platelets: Assess for thrombocytopenia.
*Crossmatch blood: Prepare for possible transfusion.

Question 3

Outline risk assessment in patients with acute upper GI bleeding

Answer 3

3- Risk Stratification Tools

A- Glasgow-Blatchford Score (GBS)
*Non-endoscopic score using clinical and laboratory data.
*Predicts need for intervention (transfusion, endoscopy, surgery).
*Components: HHuss LM

Hemoglobin

Blood urea

Systolic BP

Heart rate

Presence of melena, syncope, liver disease, or heart failure

GBS 0–1: Low risk — may be managed outpatient.

Question 4

Outline risk assessment in patients with acute upper GI bleeding

Answer 4

B-Rockall Score
*Uses clinical + endoscopic findings.
*Predicts mortality and rebleeding risk.
*Components:
A – Age
B – Blood pressure (shock: hypotension/tachycardia)
C – Comorbidities (cardiac failure, renal failure, malignancy, etc.)
D – Diagnosis (endoscopic cause: Mallory-Weiss, malignancy, ulcer, varices)
E – Evidence of bleeding on endoscopy (active bleed, visible vessel, etc.)

Question 5

Outline risk assessment in patients with acute upper GI bleeding

Answer 5

Rokall score
0-2 low risk of rebleeding and mortality
3-4 moderate risk
≥5 high risk

Question 6

High-Risk Patients

Answer 6

1-Hemodynamic instability
2-Active bleeding or high-risk stigmata on endoscopy
3-Significant comorbidities (e.g., cardiac disease, cirrhosis)
4-High Rockall or Glasgow-Blatchford scores