Upper GI Bleeding

Question 1

what is the most common cause of upper GI bleeding?

Answer 1

Duodenal ucler, gastric erosions or gastric ulcer

Question 2

what is the treatment of bleeding peptic ulcers?

Answer 2

1. endoscopic treatment
2. acid suppression
3. surgery

Question 3

what is the endoscopic treatment of peptic ulcers?

Answer 3

1. injection (adrenaline 1:10000)
2. heater probe coagulation
3. combinations
4. clips
5. haemospray

Question 4

how does hemospray work?

Answer 4

when it comes into contact with the blood, the powder absorbs water, then acts both cohesively and adhesively, forming a mechanical barrier over the bleeding site

Question 5

what would you use for acid suppression?

Answer 5

intravenous omeprazole (PPI)

Question 6

when would you suspect a variceal bleed?

Answer 6

• known history or cirrhosis

- history of alcohol excess, hepatitis, autoimmune liver disease, sepsis

Question 7

signs of variceal bleed

Answer 7

• spider naevi
• palmar erythema
• leukonchia
• encephalopathy
• ascites
• jaundice

Question 8

what intial considerations would you take if a GI bleed was suspected?

Answer 8

• coagulopaty (FFP/platelets/Vitamin K)
• CVP monitoring
• parenteral vitamins
• antibiotics
• hypoglucaemia
• replace K+, Mg2+ and PO4

Question 9

how would you achieve haemostatis?

Answer 9

1. Terlipressin (vasopressin analogue)
2. Endoscopic variceal ligation (banding)
3. Scelortherapy
4. Sengstaken-blakemore balloon
5. TIPS

Question 10

what is terlipressin?

Answer 10

• vasopressin prodrug
• ease of use: bolus 1-2mg 4 hrly
• predominantly splanchnic vasoconstrictor
• beneficial effect on renal perfusion

Question 11

what is sclerotherapy?

Answer 11

injection of drug into veins to shrink them