Upper GIB

Question 1

What determines upper versus lower?

Answer 1

Proximal or distal to ligament of Treitz. Upper GIB is more common

Question 2

Symptoms of UGIB

Answer 2

hematemesis, hematochezia if a brisk UGIB

Question 3

Differential of UGIB

Answer 3

Peptic ulcer (33.9%), Esophagogastric varices (32.8%), erosive esophagitis (8.1%), Mallory Weiss tear (6.4%), Erosion, tumor, esophageal ulcer, portal gastropathy, dieulafoy lesion, cameron lesion

Question 4

Differential of brisk or severe UGIB

Answer 4

Peptic ulcer, esophageal varices, dieulafoy lesion, aortoenteric fistula, hemobilia, hemosuccus pancreaticus, neoplasms

Question 5

What is the Glasgow-Batchford score?

Answer 5

Best validated and most useful risk stratification tool to guide decisions regarding urgent endoscopy. Nine variables. BUN, hemoglobin, systolic BP, HR, melon, syncope, hepatic disease and cardiac failure.

Question 6

Pre-endoscopic care.

Answer 6

Crystalloid IVF resuscitation to achieve HR 100.
Blood transfusion if hemodynamically unstable or history of ischemic heart disease or hemoglobin 3.0.
Give octeotride + antibiotics before endoscopy for suspected variceal bleeding.

Question 7

Endoscopic Evaluation and Treatment

Answer 7

Guidelines recommend UE within 24 hours of presentation unless a variceal bleed is suspected, in which case, 12 hours is recommended. Oral PPI can be given for clean base ulcers or flat pigmented spot and they should be allowed to eat. All others require IV PPI for 72 hours, which reduces rebleeding, need for surgery and mortality. Consultation with surgery and IR for embolization may be helpful in severe UGIB