Print Friendly, PDF & Email

Common upper GI bleed exam questions for medical finals, OSCEs and MRCP PACES

 

Question 1.

What are the common causes of upper GI bleeds?

  • Peptic ulcer disease –  oesophageal, gastric or duodenal ulcers
    • Prevalence 4% of the population
    • Due to H. pylori, NSAID use, alcohol, steroid use, Zollinger-Ellison syndrome (gastrin-secreting tumour causing multiple ulcers)
  • Oesophagitis and gastroduodenal erosions (15%)
    • Due to aspirin, other NSAIDS, steroids etc.
  • Oesophageal varices
    • Due to portal hypertension, usually associated with chronic liver disease
  • Portal hypertensive gastropathy
  • Mallory-Weiss tears
    • Secondary to prolonged vomiting
  • Dieulafoy’s lesion
    • Tortuous arteriole usually upper part of lesser curve, bleeding occurs through a tiny defect.
  • GORD
  • Upper GI malignancy
  • Vascular malformations
  • Aorto-enteric fistula (commonest at approx 5 years post-surgery. Approx 2% risk)

 

Question 2.

What is the initial resuscitation management of upper GI bleed?

  • Resuscitation
    • A – manage airway and consider need for intubation/airway adjunct or suctioning
    • B – give oxygen to maintain sats > 96%
    • C –
      • BP, HR
      • Large-bore IV access x 2
      • VBG to assess Hb, acidosis, lactate
      • Send lab bloods for FBC, U+Es, clotting, X-match (2-4 units usually)
      • IV fluid resuscitation (crystalloid is fine acutely)
    • D – AVPU, check glucose level
    • E – ?peritonitic abdomen

 

Question 3.

What are the common scoring systems in upper GI bleeds?

  • Rockall
    • Prognosticates
    • Age, Shock, Co-morbidities
      • Diagnosis and stigmata after endoscopy
    • Scores below 2 have a very low mortality
    • Scores 8 or higher have a mortality of 40%+
  • Blatchford-Glasgow
    • Risk stratify – predicts the need for hospital-based intervention
      • Urea, Hb, Systolic BP
      • Other: pulse, melaena, syncope, hepatic disease, cardiac failure
    • Use acutely but not as good as Rockall in predicting overall mortality
    • Score 0 = home
    • Score >0 = endoscopy
    • Score >5 (6 and up) = same day endoscopy