4.3 C) Gastrointestinal Bleeding

Front 1

Causes of UGIB?

Back 1

1. Peptic Ulceration
a. Helicobacter pylori
b. NSAIDS
c. smoking
d. alcohol
2. Gastroduodenal erosions / Oesophagitis
3. Oesophagogastric varices 10%
4. Mallory-Weiss Tears 15%
5. Other [ angiodysplasia ; aortoenteric fistula}

Front 2

Indications for urgent endoscopy

Back 2

1. Active / recurrent bleeding
2. BRIGHT RED haematemesis
3. Large bleeds ( > 2 units transfused)
4. Suspected VARICEAL BLEEDING

Front 3

UGIB Endoscopy Benefits

Back 3

1. Achieve haemostasis 90% cases
2. Reduce re-bleeding by 62%
3. Reduce emergency surgery by 64%
4. Reduce mortality by 45%

Front 4

Indications for Emergency Surgery in UGIB?

Back 4

1. Failure to respond to endoscopic therapy
2. Blood transfusion > 5 units
3. Refractory shock

Front 5

Stepwise Specific Mx Options for UGIB {ED-->OT}

Back 5

1. Pharmacological
a. PPI
b. Octreotide
2. Endoscopy
a. Sclerotherapy {EST} adrenaline / thermal coaptive therapy
b. variceal ligation
3. Balloon Tamponade : Minnesota Tube
4. TIPS {Transjugular Intrahepatic Portosystemic shunt }
5. Surgery {6-8%}