Upper GI Bleeding

Question 1

Causes: AAA

Answer 1

AAA

Question 2

Aetiology/ Risk Factors: What are the causes of upper GI bleeding we can find upon doing an endoscopy (11)

Answer 2

Causes:

• Peptic ulcer (gastric and duodenal) – MOST
• Oesophageal ulcer
• Oesophagitis
• Gastritis
• Duodenitis
• Oesophageal varices
• Gastric varices
• Oesophageal cancer
• Gastric cancer
• Mallory Weiss tear
• Angiodysplasia in the stomach and duodenum

Question 3

Pathology: XXX

Answer 3

XXX

Question 4

Symptoms and signs: How does a patient with upper GI bleeding present?

Answer 4

How a patient presents (signs and symptoms):

• Haematemesis (caused by a bleed anywhere above the jejunum)
• Melaena (black tarry stools, not fresh blood!)
• Reflux
• Epigastric pain
• Dyspepsia

Question 5

Investigations: What investigation do we perform for upper GI bleeding?

Answer 5

• Upper GI endoscopy (within 24 hours, sooner if the patient is unstable) - Diagnostic and therapeutic

Question 6

Treatment: How do we manage a patient with GI bleeding?

Answer 6

Management of upper GI bleeding requires PROMPT RESUSITATION:
- Protect the AIRWAY

• Give high flow O2 to help with BREATHING
• To ensure adequate CIRCULATION, gain IV access to give IV fluids. Using an IV cannula, take bloods (FBC, U+E, LFTs, coagulation) and cross match before doing a blood transfusion (if Hb<70g/L). Insert a urinary catheter. Tranexamic acid to inhibit clot breakdown.
• DISABILITY
• EXPOSURE
• Urgent ENDOSCOPY once stable
• Correct clotting abnormalities by giving VITAMIN K
• IV platelets or FFP if ongoing bleeding

Question 7

Complications: XXX shock

Answer 7

XXX shock?

Question 8

Extra: AAA

Answer 8

AAA