GI - Upper GI Bleed

Question 1

What risk assessment tools do you use for upper GI bleeds?

Answer 1

• Blatchord score at first assessment

- Full Rockall score after endoscopy

Question 2

What are the components of the Blatchford score?

Answer 2

• Urea (the higher the bigger the score)
• Hb (the lower the bigger the score)
• Systolic BP (the lower the higher the score)
• Other markers: pulse, presentation with melaena, presentation with syncope, hepatic disease, cardiac failure

Question 3

Outline resuscitation guidelines for major upper GI bleeds

Answer 3

• ABCDE, 2 wide bore IV access
• Platelet transfusion if actively bleeding or platelet count less than 50 x 10^9/Litre
• FFP to pts who have fibrinogen <1g/L or PT/APTT >1.5 times normal
• Protrombin complex to pts who are takin warfarin and actively bleeding

Question 4

What do you offer post resus?

Answer 4

• Endoscopy: offered immediately after resus in pts with severe bleed
• All pts should have endoscopy within 24h

Question 5

Outline Mx for non-variceal bleeding

Answer 5

• NICE do not recommend use of PPI b/c endoscopy to pts with suspected non-variceal upper GI bleed
• If further bleeding can: repeat endoscopy, interventional radiology or surgery

Question 6

Management of variceal bleeding

Answer 6

• Terlipressin and prophylactic antibiotics (quinolone) should be given to pts at presentation (b/f endoscopy)
• Band ligation: should be used for oesophageal varices and injections of N-butyl-2-cyanoacrylate for pts with gastric varices
• TIPS (transjugular intrahepatic portosystemic shunts): should be offered if bleeding from varices not controlled with above measures

Question 7

Describe prophylaxis of variceal haemorrhage

Answer 7

• Propanolol: reduced rebleeding and mortality compared to placebo
• Endoscopic variceal band ligation: superior to endoscopic sclerotherapy - should be done at 2week intervals until all varices completely eradicated
• PPI cover given to present EVL-induced ulceration