GI Bleed Mx



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)


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.

Risk assessment

ALL patients should have a Blatchford score at first assessment [BMJ 2017;356:i6432].

Blatchford Score
Risk for GI Haemorrhage.

Blood Urea (mmol/l) Score Total
6.5 - 8 2
8 - 10 3
10 - 25 3
>25 6
Systolic BP Score Total
>100 1
90 - 100 2
<90 3
Hb (g/dL) Men Score Total
12 1
10 - 12 3
<10 8
Hb (g/dL) Women Score Total
10 - 12 1
<10 6
Other markers Score Total
Pulse > 100 1
Presentation with melena 1
Presentation with syncope 2
Hepatic disease 2
Cardiac failure 2

Total

   


Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 13/12/21.