Upper GI Bleed Flashcards
Define the term “Haematemesis”
vomiting up fresh blood
Define the term “Melaena”
passing of black tarry faeces discoloured by the presence of digested blood.
What causes “coffee ground” vomit
caused by vomiting digested blood that looks like coffee grounds.
What is the classic presentation of a patient with an upper GI bleed
Patients commonly present with haematemesis and/or melaena and may have features of shock (e.g. hypotension, collapse).
Name the three causes that account for the majority of upper GI bleeds
Peptic ulcer disease
Gastritis
oesophageal varices
Name the 2 causations of peptic ulcer
Helicobacter pylori
The use of NSAIDs
Name some of the oesphageal causes of upper GI bleed
Varices
Oesphagitis
Maligancy
Name some of the gastric causes of upper GI bleed
Peptic ulcers
Gastritis
Mallory-Weiss
Malignancy
Name some of the duodenal causes of upper GI bleed
Peptic ulcers
Duodenitis
Diverticulum
Aorto-duodenal fistula
What are oesphageal varices
Abnormal, dilated veins that occur at the lower end of the oesophagus
Oesophageal varices occur secondary to portal hypertension most commonly secondary to cirrhosis.
Describe the physiology on how portal hypertension can cause oesphageal varcies
Increases in portal pressure lead to the development of a collateral circulation to overcome the obstruction to flow in the portal system.
The lower end of the oesophagus forms an important ‘portacaval anastomosis’which allows the flow of venous blood from the portal system to the systemic circulation.
Several risk factors increase the likelihood of a patient developing an upper GI bleed.
Name some of these risk factors
NSAIDs
Anticoagulants
Alcohol abuse
Chronic liver disease
Chronic kidney disease
Advancing age
Previous peptic ulcer disease or H. pylori infection
What is the main diagnostic test for upper GI bleed
Upper GI endoscopy
Upper GI endoscopy is the main diagnostic test for upper GI bleed.
Within what time scale should this be completed
immediately in any unstable patient following initial resuscitation
within 24 hours in all other patients
Early risk stratification helps identify high-risk patients & need for prompt intervention.
Name the two scoring systems used in upper Gi bleed
Blatchford score
Rockall
Which upper GI bleed scoring system is recommended during the primary assessment
Blatchford score
Which upper GI bleed scoring system takes into account endoscopy findings
Rockall scoring
Name some of the components of the Blatchford score
Drop in Hb
Rise in urea
Blood pressure
Heart rate
Melaena
Syncope
Why is there a rise in urea in upper GI bleeds
the blood in the GI tract gets broken down by the acid and digestive enzymes.
One of the breakdown products is urea and this urea is then absorbed in the intestines.
What are the components of the Rockall scoring system
Mnemonic ABCDE:
A - Age
B - Blood pressure (and heart rate)
C - Comorbidity
D - Diagnosis
E - Endoscopic findings
What is the most common cause of non-variceal upper GI bleeding
Peptic ulcer disease
The risk of rebleeding of non-variceal upper GI bleeds, which influences the need for intervention, depends on
The endoscopic findings of the ulcer.
If based on the endoscopic findings. If the non-variceal upper GI bleed is deemed high risk of rebleeding
What is the next management option
Endoscopic intervention (Endo-therapy)
What techniques are employed in endo-therapy to treat the bleed
Adrenaline injection
Thermal coagulation by a heater probe
Mechanical e.g. endoscopic clips
Haemostatic powders
(thrombin, laser)
