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.
At CUH, patients presenting hypotensive (Sys BP < 100mmHg) or Hb < 10 g/dl should be admitted under the surgical team on call. (Letter)
- Offer endoscopy to unstable patients immediately after resuscitation (see varices page)
- Offer endoscopy to all others within 24 hours of admission
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.
ALL patients should have a Blatchford score at first assessment [BMJ 2017;356:i6432].
Risk for GI Haemorrhage.
|Blood Urea (mmol/l)||Score||Total|
|6.5 - 8||2|
|8 - 10||3|
|10 - 25||3|
|90 - 100||2|
|Hb (g/dL) Men||Score||Total|
|10 - 12||3|
|Hb (g/dL) Women||Score||Total|
|10 - 12||1|
|Pulse > 100||1|
|Presentation with melena||1|
|Presentation with syncope||2|