Upper GI Flashcards

1
Q

what are the common causes of an upper GI bleed?

A

peptic ulcer disease in 35-50% gastrodudodenal erosions oesophagitis mallory-weiss tear varyx other: malignancy, AV malformation, swallowed blood (haemoptysis, facial trauma, epistaxis)

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2
Q

what are the clinical calculators applicable to upper GI management decisions?

A

Rockall (Pre-endoscopy/complete) Glasgow-Blatchford (better)

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3
Q

what is the Hb limit for transfusion in an upper GI bleed?

A

<70 g/L

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4
Q

if you suspect oesophageal varicies as the cause for an upper GI bleed, how does this change the management?

A

have to take liver failure into consideration (should already have LFTs ordered)

need to compensate for their clotting deficiency

give terlipressin IV 1-2 mg/6 hrs for <3 days

give tazocin IV 4.5 g/8 hours

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5
Q

what aspects of the history would make you consider oesophageal varicies?

A

history of liver failure or EtOH excess.

currently intoxicated or smells of alcohol

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6
Q

is endoscopy fails to control the bleeding, what are the second line treatment options for

1) oesophageal varyx
2) anything else

A

1 - Sengstaken-Blakemore tube sited by an senior

2- surgery or mesenteric angiography/embolisation

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7
Q

what is the role for PPI therapy in upper GI bleed?

A

none pre-endoscopy

give omeprazole 40 mg IV/PO OD following haemostasis

if underlying H pylori infection, treat with triple therapy

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8
Q

what is triple therapy for H pylori?

A

omeprazole 40 mg po bd

amoxicillin 1 g po bd

clarithromycin 500 mg/metronidazole 400 mg po bd

check with local guidelines

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9
Q

what is the significance of a rebleed?

A

40% of patients who rebleed will die

if it occurs, do obs q15 mins and call for senior help

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10
Q

how do you test for H pylori?

A

13-C breath test or presence of stool antigen

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11
Q

what does the Blatchford score tell us?

what are some of the advantages of the Blatchford score over the Rockall score?

A

main purpose: to identify low-risk patients that can successfully be managed as an outpatient.. i.e. low Blatchford score is validated to support NOT ADMITTING

  • can be used pre-endoscopy
  • it does not count on a subjective assessment of the severity of systemic disease
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