Background
- Please note separate pages on Variceal Bleed and GI Bleed Mx in MUH.
- Each Upper GI Bleed has 10% mortality.
- Mortality higher in elderly and those with co-morbidities.
- Commonest causes are PUD and Oesophogastric varices.
- Endoscopy aids Dx, helps with prognosis is may be therapeutic.
- Complimentary drugs aim to ↓gastric acid or portal vein pressure.
- Early surgery (or radiological intervention) is advised for those who do not respond to endoscopy/medical management.
CUH Admissions
At CUH, patients presenting hypotensive (Sys BP < 100mmHg) or Hb < 10 g/dl should be admitted under the surgical team on call. (Letter)
Risk assessment
ALL patients should have a Blatchford score at first assessment [BMJ 2017;356:i6432].
Blatchford Score - Admission Risk Markers for GI Haemorrhage.
Blood Urea (mmol/l) |
|
6.5 - 8 |
2 |
8 - 10 |
3 |
10 - 25 |
3 |
>25 |
6 |
Systolic BP |
Score |
>100 |
1 |
90 - 100 |
2 |
<90 |
3 |
Haemoglobin (g/dL) Men |
Score |
12 |
1 |
10 - 12 |
3 |
<10 |
8 |
Haemoglobin (g/dL) Women |
Score |
10 - 12 |
|
<10 |
6 |
Other markers |
Score |
Pulse > 100 |
1 |
Presentation with melena |
1 |
Presentation with syncope |
2 |
Hepatic disease |
2 |
Cardiac failure |
2 |
|
|
Total |
Blatchford 0, et al. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet 2000:356 1318-21
Endoscopy timing
- Offer endoscopy to unstable patients immediately after resuscitation (see varices page)
- Offer endoscopy to all others within 24 hours of admission
Non-variceal bleed
For endoscopic treatment use:
- Mechanical method e.g. clips ± Adrenaline.
- Thermal coagulation with Adrenaline.
- Fibrin or thrombin with Adrenaline.
Consider interventional radiology in unstable patients who re-bleed after endoscopy.
More on Variceal Bleed.