Background
- Please note separate page on Variceal Bleed.
- 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 and 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 Agreed Pathway
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
- 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.
Links
- Print copy CUH Upper GIB Pathway
- GI Bleed Lower CUH
- Senkstaken tube
- Reversing DOACs
- Reversing warfarin
- 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