Upper GI Bleeding

Question 1

what causes it

Answer 1

duodenal ulcers and duodenitis 
mallory-weiss tear 
gastric ulcer and gastritis 
reflux oesophagitis 
oesophageal varices (consequence of portal HT and if known history of cirrhosis with varices)
gastric carcinoma

Question 2

what are symptoms

Answer 2

haematemesis

coffee-ground vomiting or malaenia (black tarry faeces)

Question 3

how is it diagnosed

Answer 3

severity measured by 100 rule:
systolic BP <100
pulse >100
Hb<100
rockall and blatchford scoring systems

Question 4

what treatment given to all ulcers

Answer 4

ABCDE
airway protection, oxygen, IV fluids
take bloods for cross matching (consider giving O- if delay), haemoglobin, clotting, U&Es and ABGs in shocked patient

Question 5

what treatment for bleeding peptic ulcer

Answer 5

endoscopy has therapeutic options - adrenaline injection, heater probe coagulation, haemospray as last resort, sclerotherapy for varices
when bleed stops, give omeprazole
if rebleed after initial healing - omeprazole + another endocopy
if bleeding continues, do surgery

Question 6

what is treatment for visceral bleed

Answer 6

resuscitation, antibiotics, terlipressin and early endoscopy (OGD)
bleed stops - propranolol and banding programme
bleeding continues - EVL or S-B tube, if continues then TIPSS -> observe if hepatic function good, transplant if poor