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GI: symptoms and miscellaneous > Upper GI Bleeding management > Flashcards

Upper GI Bleeding management Flashcards

1
Q

people who present with upper GI bleed (haematemesis or meleana) should be considered ____ until proven otherwise

A

severe

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2
Q

____% self limiting with no hospital re-bleed

A

80%

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3
Q

patients who continue to bleed or recurrency of bleeding have a mortality of __-___%

A

30-40%

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4
Q

death in an upper GI bleed is due to ____ and rarely ____

A

Death is due to complications, rarely exsanguination (blood loss)

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5
Q

the real key to saving patients is to make sure they are _____ properly

A

resuscitated properly

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6
Q

what are the 4 main causes of upper GI bleed?

A
  • duodenal ulcer - 24%
  • gastric ulceration - 23%
  • gastric ulcer - 21%
  • varices - 10%
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7
Q

what are some less common causes of upper GI bleed? 7

A
  • Mallory weiss tear - tear in bottom of oesophagus from vomiting
  • Oesophagitis
  • Erosive duodenitis
  • Neoplasm
  • Stomal ulcer
  • Oesophageal ulcer
  • Miscellaneous
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8
Q

what are the parts involved in resuscutation?

A

ABCDE

  • oxygen
  • IV access
  • fluids!!
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9
Q

how do you assess the severity of the heamorrhage - the 100 rule (6)

A
  • Systolic BP 100
  • Hb 60
  • Comorbid disease
  • Postural drop in blood pressure
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10
Q

Young people _____ and then ___ ___

A

compensate and then crash hard

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11
Q

which group of patients have poor autonomic responses so don’t indicate to you in terms of BP responses or cardiac responses

A

diabetics

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12
Q

which drug may show a falsely low pulse?

A

beta blocker

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13
Q

the treatment of these patients involves _____ and then prompt ____

A

resuscitation and then prompt endoscopy

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14
Q

what three things can endoscopy be used for?

A
  • identifying the cause
  • therapeutic moves
  • assess the risk of rebleeding
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15
Q

People with ___, ___ , ___ or ____ failure and _____ have a really high mortality with GI bleeding

A

People with IHD, CCF renal or liver failure and malignancy have a really high mortality with GI bleeding

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16
Q

the blatchford score is used to ___ people

A

triage

17
Q

__-___ means there is a very low risk and the person can be discharged - blatchford

A

0-1

18
Q

what does a blatchford score of >6 indicat?

A

the person needs aggressive observation, resuscitation and endoscopy asap

19
Q

what things can cause recent haemorrhage with an ulcer? 3 - these are the three stigmata for endotherapy

A
  • active bleeding/oozing
  • overlying clot
  • visible vessel - ulcer has eroded into an underlying small arteyr
20
Q

which part of the ulcer is biopsied ?

A

the edge - there is no point doing the middle - it is just necrotic cells

21
Q

what are the 4 treatment options with peptic ulcers?

A
  1. endoscopic treatment - high risk ulcers
  2. acid suppression
  3. surgery
  4. H.Pylori eradication
22
Q

what are the 5 methods of endotherapy for PUD?

A
  1. injection
  2. heater probe coagulation
  3. combination of 1 and 2
  4. clips
  5. haemospray - if out of control
23
Q

what is the injection? for ulcers

A

1/10000 adrenaline

24
Q

how does adrenaline act to help the ulcer? 2

A
  • volume expansion - squishes the vessel

- adrenline vasoconstrics the vessels

25
Q

what is usually done in practice in endotherapy of ulcers?

A

heater probe coagulation and injection of adrenaline

26
Q

what is the acid suppression treatment in PUD?

A

IV omeprazole

27
Q

acute variceal bleeding usually occurs in the context of ___

A

cirrhosis

28
Q

what complications can cause mortality with variceal bleeding?

A

sepsis and liver failure

29
Q

when should you suspect varices in a bleeder? 5

A
  • known history of cirrhosis with varices
  • chronic alcohol excess
  • chronic viral hepatitis
  • metabolic or autoimmune liver disease
  • intra-abdominal sepsis
30
Q

what are the main aims of treatment in a variceal bleeder? 4

A
  • resuscitation
  • haemostasis
  • prevent complications of bleeding
  • prevent re-bleeding
31
Q

how do you achieve haemostasis in a variceal bleeder? 4

A
  • terlepressin
  • endoscopic variceal ligation
  • sengstaken blakemore balloon
  • TIPSS
32
Q

what is terlepressin ?

A

a vasopressin analogue causing vasoconstriction predominently in the splanchnic vessels - so there is reduced output through the portal vein

33
Q

the ballon used in treatment of varices is only a ___ measure so that we can ___ better

A

temporary, resuscitate

34
Q

what are some initial considerations for people presenting with variceal bleeding?

A
  • Coagulopathy (FFP/platelets/ vitamin K)
  • CVP monitoring (portal pressure vs CVP)
  • Parenteral vitamins
  • Antibiotics
  • Unexpected pathology - perforated DU example
  • Hypoglycaemia - liver patient
  • Replace k mg and po4 electrolytes
  • Delirium treatments

GI: symptoms and miscellaneous (3 decks)

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