Upper GI Bleeding management Flashcards
(34 cards)
people who present with upper GI bleed (haematemesis or meleana) should be considered ____ until proven otherwise
severe
____% self limiting with no hospital re-bleed
80%
patients who continue to bleed or recurrency of bleeding have a mortality of __-___%
30-40%
death in an upper GI bleed is due to ____ and rarely ____
Death is due to complications, rarely exsanguination (blood loss)
the real key to saving patients is to make sure they are _____ properly
resuscitated properly
what are the 4 main causes of upper GI bleed?
- duodenal ulcer - 24%
- gastric ulceration - 23%
- gastric ulcer - 21%
- varices - 10%
what are some less common causes of upper GI bleed? 7
- Mallory weiss tear - tear in bottom of oesophagus from vomiting
- Oesophagitis
- Erosive duodenitis
- Neoplasm
- Stomal ulcer
- Oesophageal ulcer
- Miscellaneous
what are the parts involved in resuscutation?
ABCDE
- oxygen
- IV access
- fluids!!
how do you assess the severity of the heamorrhage - the 100 rule (6)
- Systolic BP 100
- Hb 60
- Comorbid disease
- Postural drop in blood pressure
Young people _____ and then ___ ___
compensate and then crash hard
which group of patients have poor autonomic responses so don’t indicate to you in terms of BP responses or cardiac responses
diabetics
which drug may show a falsely low pulse?
beta blocker
the treatment of these patients involves _____ and then prompt ____
resuscitation and then prompt endoscopy
what three things can endoscopy be used for?
- identifying the cause
- therapeutic moves
- assess the risk of rebleeding
People with ___, ___ , ___ or ____ failure and _____ have a really high mortality with GI bleeding
People with IHD, CCF renal or liver failure and malignancy have a really high mortality with GI bleeding
the blatchford score is used to ___ people
triage
__-___ means there is a very low risk and the person can be discharged - blatchford
0-1
what does a blatchford score of >6 indicat?
the person needs aggressive observation, resuscitation and endoscopy asap
what things can cause recent haemorrhage with an ulcer? 3 - these are the three stigmata for endotherapy
- active bleeding/oozing
- overlying clot
- visible vessel - ulcer has eroded into an underlying small arteyr
which part of the ulcer is biopsied ?
the edge - there is no point doing the middle - it is just necrotic cells
what are the 4 treatment options with peptic ulcers?
- endoscopic treatment - high risk ulcers
- acid suppression
- surgery
- H.Pylori eradication
what are the 5 methods of endotherapy for PUD?
- injection
- heater probe coagulation
- combination of 1 and 2
- clips
- haemospray - if out of control
what is the injection? for ulcers
1/10000 adrenaline
how does adrenaline act to help the ulcer? 2
- volume expansion - squishes the vessel
- adrenline vasoconstrics the vessels
