Upper GI bleed
| definition: Bleeding from GIT above ligament of Trietz. | |
|---|---|
| Etiology | Varices, H pylori, peptic ulcers, NSAIDs, alcohol, trauma - Boerhaave syndrome, Mallory-Weiss tears... See below for some organisation. |
| Clinical presentation | symptoms: shock, frank blood from mouth or rectum, malaena (i.e. BLACK tarry stool) bloods: uraemia, anaemia risk stratification: Glasgow Blatchford score or Rockall score |
| Pathogenesis | Peptic ulcer disease: direct erosion into a blood vessel Liver disease: Cirrhosis ⇒ ↑ inflow via mesenteric art vasodilatation + ↓ outflow via splanchnic |
| Diagnostic investigations | ABG - lactate, calcium, Hb U+E - urea LFTs - liver synthetic function FBC, coag, TEG - coagulopathy G+S - for impending transfusion |
| Management | Resuscitation: ➥ Hb targets don't change unless ischaemic heart disease... still 7g/dL ➥ If variceal bleed (chronic liver disease, past dx), start terlipressin infusion (s/e: digital ischaemia) + prophylactic abx (tazocin); balloon tamponade ➥ Stop any contributing drugs eg NSAIDs, anticoagulants/antiplatelets, corticosteroids ➥ NO EVIDENCE FOR PPIs pre-endoscopy, or for TXA... Ongoing: ➥ varices: sclerotherapy ➥ ulcer: adrenaline injection, clipping |
classify or die: etiologies
by anatomy
- Oesophageal source
- Mallory-Weiss tears
- erosive oesophagitis
- Stomach
- peptic ulcer
- gastric varices
- portal hypertensive gastropathy
- Anywhere else
- foreign body ingestion
- Dieulafoy lesion (arteriovenous malformation)