Management of acute upper GI haemorrhage Flashcards Preview

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Flashcards in Management of acute upper GI haemorrhage Deck (18)
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1
Q

What is haematemesis?

A

Thick, clotted bright red blood that is vomited

2
Q

What is melaena?

A

Passes through small bowel, producing melaena (black, thick, sticky, semi liquid stool)

3
Q

What is a mallory-weiss tear?

A

Distal oesophageal lining can tear in repeated vomiting

4
Q

What type of canulla should be placed in the case of haemorrhage?

A

Large bore IV in each antitubercular fossa

5
Q

How is the severity of the haemorrhage determined?

A
Systolic BP <100 mmHg
Pulse >100.min
Hb <100 g/l
Age >60
Comorbid disease
Postural drop in BP
6
Q

Who presents differently to haemorrhage?

A

Young people compensate then crash hard
Diabetics have a poor autonomic response - don’t respond with tachycardia
Beta-blockers prevent reflex tacycardia

7
Q

What is the purpose of the endoscopy?

A

Identify cause
Theraputic manoeuvres
Assess risk of rebleeding

8
Q

What can endoscopy be used to treat?

A

Bleeding peptic ulcers

Variceal bleeding

9
Q

What is the stigmata of recent haemorrhage?

A

Active bleeding, oozing, overlyling clot, visible vessel

10
Q

How can chronic gastric uclers be treated?

A
Endoscopic treatment 
Acid suppression 
Interventional radiology
Surgery 
H. Pylori eradication
11
Q

How can peptic ulcers be treated endoscopically?

A
Injection of adrenaline causing vasoconstriction 
Heater probe coagulation 
Combinations 
Clips
Haemospray
12
Q

How can acid suppressino be achieved?

A

IV omperazole

13
Q

When should varices be suspected in upper GI haemorrhage?

A
Known history of cirrhosis 
Chronic alcohol excess
Chronic viral hepatitis infection 
Metabolic or autoimmune liver disease 
Intra-abdominal sepsis/surgery
14
Q

What are the aims of management of uppper GI bleeding?

A
Resucitation 
Haemostasis
Prevent complications of bleeding
Prevent deterioration of liver function 
Prevent early re-bleeding
15
Q

What should be considered when managing upper GI bleeding?

A
Coagulopathy (FFP/platelets/vit K) 
CVP monitoring
Parenteral vitamins
Antibiotics
Unexpected pathology e.g. perforated D.U 
Hypoglycaemia
Replace K+, Mg 2+ and PO42-
Delirium tremens
16
Q

What is the initial managemnet for variceal bleeds?

A

Resucititation, antibiotics, terlipressin (reduces splanchnic flow), early OGD

17
Q

What should occur if bleeding stops?

A

Propanolol (reduces portal blood pressure) and banding programme

18
Q

What hsould be done in bleed continues?

A

EVL (bainding) or S-B tube

Then TIPPS