Upper GI Bleed

Question 1

what are the symptoms of upper GI bleed?

Answer 1

• haematemesis
• melena

Question 2

what are the causes of upper GI bleeds?

Answer 2

• oesophageal/gastric varices
• peptic ulcer disease (H. pylori, NSAID use, smoking)
• malignancy
• aorto-enteric fistula (previous AAA or an aortic graft)
• angiodysplasia
• mallory weiss tear

Question 3

what is the management of an upper GI bleed?

Answer 3

A-E assessment
* IV fluid resuscitation and blood transfusion (if HB <7)
* NBM
* supplemental oxygen
* IV PPI

Question 4

how is a variceal bleed managed?

Answer 4

• IV terlipressin
• antibiotics (e.g. piperacillin/tazobactam)

Question 5

what investigation is carried out once the patient is stable?

Answer 5

upper GI endoscopy to locate the source of bleed. attempt to stop through adrenaline injection and ulcer clipping

Question 6

what is the rockall score?

Answer 6

risk assessment tool that predicts mortality in upper GI bleed patients. it can be calculated pre-endoscopy (max score 7) or post-endoscopy (max score 11)

Question 7

what is the recommendation for a rockall score >0?

Answer 7

inpatient oesophago-gastro-duodenoscopy (OGD)

Question 8

what is the recommendation for a rockall score of 0?

Answer 8

urgent outpatient oesphago-gastro-duodenoscopy (OGD)

Question 9

what is the glasgow-blatchford score?

Answer 9

preferred by NICE pre-endoscopy for deciding upon timing of the procedure

<0 = outpatient

Question 10

what parameters make up the glasgow-blatchford score?

Answer 10

• urea
• haemoglobin
• systolic blood pressure
• tachycardia
• clinically observed melena
• syncope
• liver disease
• heart failure

Question 11

what can be quickly used to reverse the effects of warfarin during a major haemorrhage?

Answer 11

prothrombin complex concentrate

contains factors II, VII, IX, X

Question 12

what are the 2 major causes of high urea?

Answer 12

• high-protein diet
• upper GI bleed

Question 13

what is oesophageal varices?

Answer 13

dilated collateral vessels in the stomach and oesphagus that form as a result of portal hypertension. they act to divert pressure away from the portal system into the systemic circulation and are prone to rupture

Question 14

what medication can be used as secondary prophylaxis of variceal haemorrhage?

Answer 14

non-selective beta blockers are given to reduce re-bleeding and help with hepatic decompression

propranolol