Where is a bleed from in an upper GI bleed?
- Oesophagus
- Stomach
- Duodenum
What can cause an upper GI bleed?
- Oesophageal varices
- Mallory-Weiss tear
- Peptic ulcers
- Stomach or duodenal cancer
What is a Mallory-Weiss tear?
Tear of the oesophageal mucous membrane
Often caused by persistent vomiting
o Alcohol intoxication
o Self-induced vomiting
o Pregnancy
What could an upper GI bleed present with?
- Haematemesis
- Coffee ground vomit
- Melaena
- Iron-deficiency anaemia
- Haemodynamic instability
Which risk assessment tool do you use first?
Glasgow-Blatchford risk score (GBS)
What does the Glasgow-Blatchford risk score (GBS) look at?
- Urea
- Hb
- Systolic BP
- Pulse
- Melaena
- Syncope
- Hepatic disease
- Cardiac failure
Why does urea rise in a GI bleed?
Blood in GI tract is broken down by acid and digestive enzymes.
One of the breakdown products is urea
When do you do the Rockall score (RS)?
After endoscopy
• Score <3 carries a good prognosis
How do you manage an acute upper GI bleed?
ABATED • A - ABCDE approach • B - Bloods o H - Hb (FBC) o U - Urea (U+Es) o C - Coagulation (INR, FBC for platelets) o L - Liver disease (LFTs) o C - Crossmatch 2 units of blood • A - Access (2 large cannulas) • T - Transfuse • E - Endoscopy (within 24hrs) • D - Drugs (stop anticoagulants and NSAIDs)
Which medications are linked with the formation of peptic ulcers or GI bleeds?
- Potassium channel activators – Nicorandil
- Antiplatelets
- Anticoagulants
- NSAIDs
- SSRIs
- Corticosteroids
What do potassium channel activators (Nicorandil) increase the risk of?
GI ulceration
