Upper GI bleeds Flashcards
What counts as an upper GI bleed?
Duodenum and above
Small bowel doesn’t tend to bleed
What is occult bleeding?
When the bleeding can only be detected microscopically
What are some of the common causes of upper GI bleeds?
Peptic ulcers Mallory-Weiss tear Oesophageal varices Gastritis Drugs (NSAIDs, aspirin) Oesophagitis Duodenitis Malignancy
What are the initial stages of management of a patient with an upper GI bleed? What blood need doing?
ABCDE approach
Need to give 15L oxygen
Insert 2 large bore cannulae and take blood for FBC, u and e, LFT, clotting and cross-match
After bloods how should the patient be managed?
Give IV fluids to restore intravascular volume, give o neg blood if deteriorating while waiting for cross matched blood
Insert urinary catheter and monitor output
When should saline for resus be avoided in upper GI bleed?
If cirrhosis/varices
What investigations should be done for upper GI bleed?
Erect chest XR
ECG
ABG
If varices are suspected for cause of upper GI bleed then what is the management?
Give terliprssin (ADH analogue) Give prophylactic antibiotics
How are upper GI bleeds stopped?
Can be done endoscopically by ligation or sclerotherapy
If this fails can use interventional radiology or surgery
A sengstaken-blakemore tube can be used to compress the varices
What score can be used for upper GI bleeds?
Rockall score
What are the components of the upper GI scoring system?
Rockall score Age Shock (systolic BP and pulse rate) Comorbidity Post endoscopic diagnosis Signs of recent haemorrhage on endoscopy
What tube can be used to compress uncontrollable oesophagela varices bleeding?
sengstaken blakemore tube
What is the relevance of urease testing following an upper GI bleed?
Can identify helicobacter pylori as this is the main cause of peptic ulcers
How is helicobacter pylori infection treated?
It is treated with PPI combined with 2 antibiotics (clarithromycin and amoxicillin)
When should a urea breath test be done and what must be stopped prior to this?
Is done 8 weeks after eradication therapy for H. Pylori
Should stop PPIs one week before breath test
