Acute Upper Intestinal GI Bleeding

Question 1

Causes?

Answer 1

• Peptic Ulceration GU & DU
• Hemorrhagic viral infections
• Drugs (NSAIDs/alcohol)
• Oesophageal varices &gastric varices
• Mallory-weiss tear
• Haemorrhagic gastropathy
• Gastric carcinoma

Question 2

How does UGI bleed present?

Answer 2

Haematemesis
Melaena (any lesion proximal to right colon)
Unaltered blood PR
Coffee ground vomit

Question 3

Indications for bleeding risk?

Answer 3

• Age
• Evidence of co-morbidity (CF, IHD, CKD, Malignancy)
• Shock

Question 4

Investigations for UGI bleed?

Answer 4

• Blood test- urea greatly raised

- Endoscopy

Question 5

What should happen at first endoscopy?

Answer 5

• Varices treated
• Stenting used for bleeding varice
• Bleeding ulcers should be injected with adrenalin & thermal coagulation
• Haemostatic powders
• Antral biopsies (for H. Pylori)

Question 6

How are varices treated?

Answer 6

With banding

Question 7

How is UGI bleed treated?

Answer 7

-If recent (last 2 days): hospital
-Assess risk of re-bleeding
and so determine need for more treatment
-Stop NSAIDs/anti-platelets
-Aftre endoscopy diagnosis give IV PPI to all active bleeders
-Embolize site if necessary

Question 8

How to assess risk of re-bleeding?

Answer 8

Rochkall score

Blatchford score

Question 9

Process of endoscopic treatment?

Answer 9

Injection 
Heater probe coagulation 
Combinations 
Clips 
Haemospray

Question 10

If an acute GI bleed?

Answer 10

• History + exam
• Monitor pulse and BP half-hourly
• Take blood (haemoglobin, urea, EL, liver biochem, coagulation screen, group, cross-matching)
• Establish IV access (2 large bore cannula)
• Give blood transfusion if necessary
• Give oxygen therapy
• Perform urgent endoscopy in shocked patients
• Arrange surgery if bleed persists

Question 11

Prognosis of upper GI bleed?

Answer 11

5-12% mortality

Rule of 100 helps determine if poor prognosis (systolic BP <100mg, HR<100, Hb<100g/l, age:>60)

Question 12

Glasgow Blatchford Scale what indicates the likelihood of a GI bleed?

Answer 12

anything over 0

Question 13

Various features of upper GI bleed?

Answer 13

• Drop in Hb
• Rise in urea
• Blood pressure
• Heart rate
• Meleana
• Syncopy

Question 14

Who is Rockhall score used for?

Answer 14

Patients who have had an endoscopy

Question 15

What does Rockhall score tell you?

Answer 15

Percentage risk for rebleeding and mortality

Question 16

Factors involved in the rockhall score?

Answer 16

A-ABCDE
B- Bloods
A- Access (ideally 2 large bore cannula)
T- Transfuse
E- Endoscopy 
D- Drugs (stop anti-coags and NSAIDs)

Question 17

Definitive treatment?

Answer 17

OGD

Oesophagogastroduodenoscopy