Upper GI Bleed (UGIB)

Not normally difficult to spot, but look for it in unexplained anaemia, or collapse.

Questions

  • Is it VARICEAL? Mortality 35%, so is an emergency whatever the GBS is.
  • Non-Variceal what’s the GBS? will help guide treatment

Anyone being admitted should be brought to HRI

Emergency Endoscopy is arranged by Med Reg

Causes

  • Variceal – 10% of Upper GI Bleeds (35% mort.) Hx indicating liver failure
  • Ulcers – Epigastric pains, reflux, dysphagia
  • Mallory-Wiess – Retching/coughing/vomiting prior to bleed
  • Malignancy – Often painless, weight loss, dysphagia

Actions for ALL

  • Full Observations
  • Cannula – large (x2 if unwell)
  • Bloods: FBC/U&E/LFT/Coag/G&S

Consider for ALL

  • Correct Anticoagulants: Discuss with Haematologist
  • Massive Transfusion Pathway: Refer to MTP guide

Consider for Variceal

  • Terlipressin 2mg IV Bolus – Mortality Risk Reduction(RR) 34%
  • IV Antibiotics (Antibiotic Page) – Mort RR 27%, Sepsis RR 60%

Glasgow-Blatchford Score

Urea levelHaemoglobin [Male]Haemoglobin [Female]Systolic BPOther
≥6·5 <8·02≥120 <130 1≥100 <1201100–1091Pulse ≥100 bpm1
≥8·0 <10·03≥100 <1203<100690–99 2Melaena1
≥10·0 <25·04<1006<903Syncope 2
≥256Hepatic disease2
Cardiac failure2

  • 0 – Suitable for Discharge (NICE)
  • 1-2 – Suitable for medical review potential discharge
  • >5 – High risk >50% will need intervention

Significant UGIB

  • Ongoing bleed, Haemodynamic instability, GBS >5, OR high suspicion of variceal bleed
  • Ensure Senior involved
  • Should be transferred to HRI (ED/AMU) Urgent assessment by Med Reg
  • Med Reg to liaise with Emergency Endoscopy + Surgical team

Emergency Endoscopist will decide: if out of hours likely to happen in theatre.

Sengstaken tube

  • Consider if endoscopy required but not possible
  • Only buys time; stops 90%, but will re-bleed within 24hr
  • Require intubation prior to insertion
    • Insert to 60cm
    • Inflate gastric balloon ONLY – 400ml/Resistance
    • Traction attach 250ml bag and hang over drip stand

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