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)
Admit vs Discharge
- well patients with a Blatchford <1 = OPD Mx
- Well patient with Blatchford 1 = discuss with your senior
- Blatchford >1 = admit
Endoscopy timing
- Offer endoscopy to unstable patients immediately after resuscitation (see varices)
- 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.
Risk assessment
Complete a Blatchford score at first assessment [BMJ 2017;356:i6432].
| Systolic BP | Score |
|---|---|
| 100-109 | 1 |
| 90-99 | 2 |
| <90 | 3 |
| Hb (g/dL) Men | Score |
| 12-12.9 | 1 |
| 10-11.9 | 3 |
| <10 | 6 |
| Hb (g/dL) Women | Score |
| 10-11.9 | 1 |
| <10 | 6 |
| Blood Urea (mmol/l) | Score |
| 6.5-8 | 2 |
| 7.9-9.9 | 3 |
| 10-25 | 4 |
| >25 | 6 |
| Other markers | Score |
| Pulse ≥ 100 | 1 |
| Melaena | 1 |
| Syncope | 2 |
| Hepatic disease | 2 |
| Cardiac failure | 2 |
Total |
Links
- Nice Guideline 141 - Mx Upper GI Bleed - June 2012
- Blatchford 0, et al. A risk score to predict need for treatment for upper GI haemorrhage. Lancet 2000:356 1318-21