Upper Gastrointestinal Bleeding

Posted by e-Medical PPT Tuesday, July 24, 2012
Upper GI bleeding
Variceal
Known varices
Signs of chronic liver disease
Prolonged INR
Low platelets
(Alcohol history)

Non-variceal
NSAID use
Preceding dyspeptic symptoms
Mallory-Weiss tear

Lower GI bleeding
Previous history of similar events
Bright red PR bleed
Dark red PR bleed
Unless massive upper GI bleed
Normal urea

Trials investiging a raised urea as a predictor of UGIB v LGIB (or no bleed)
Best results if blood sample taken 6-12 hours after event

OGD findings
Varices    ,DU/GU/pyloric ulcers,Gastritis (NSAIDs),Oesophageal ulcer,Cancers,Oesophagitis,Dielafoy

Variceal bleeding
Venous bleeding
Usually an associated coagulopathy
Drug administration recommended as early as possible (before endoscopic therapy)
Combination therapy better than drugs or endoscopy alone

Risk of Bleeding
Portal pressure - circadian change
Highest pressures at night
Increase risk with:
 severity of liver disease
 variceal size
 red markings on varix
 pressure over 12 mmHg
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