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3 Cards in this Set
- Front
- Back
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What are the differentials for UBGIT? |
1. Variceal bleed 2. Non variceal bleed: - peptic ulcer disease - gastric/esophageal malignancy - arteriovenous malformation (Dieulafoy's lesion) - Gastritis/esophagitis - mallory weiss tear - aorto-enteric fistula |
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What is the management pathway for UBGIT? |
1. Stabilize airway, breathing, circulation (use suction to suck out all NG aspirates and blood, also give oxygen via nasal prongs) - send bloods: FBC, U/E/Cr, GXM, PT/PTT, LFT, ABG, Lactate - ECG (to detect AMI), CXR (TRO perforation) 2. Adjuncts - insert NG tube to prevent aspiration, allow gastric lavage prior to OGD (AVOID IN SUSPECTED VARICES) - intubate (patient is obtunded/uncontrollable UBGIT) - catheterisation - early IV omeprazole (80mg bolus, then 8 mg/hr for 3 days) - give IV somatostatin/octreotide + IV antibiotics if suspected varices - withhold all anticoagulants/anti-platelets/NSAIDs 3. If in class 2 shock --> monitor and give fluids - give 1 L normal saline, fast. Reassess patient response afterwards - responder (will show sustained clinical and biochemical improvement) - transient responder (KIV colloids, wait for GXM) - non-responder (KIV colloids, E bloods, adjunct monitoring via CVP line--> stabilize patient before moving to scope room for emergency scope) ***give restrictive transfusion therapy to keep Hb > 7 g/dL 4. If in class 3,4 shock or active BGIT or suspected varices --> emergency OGD |
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What are the scores for a patient with UBGIT? |
1. Rockall score (includes OGD findings, history, physical examination) - score of 2 and below have low risk of re-bleed, score of 8 and above have 50% risk of re-bleed 2. Blatchford score (only clinical and lab results) - Low risk = Score of 0. Any score higher than 0 is “high risk” for needing a medical intervention of transfusion, endoscopy, or surgery. 3. AIMS 65 score (prognosticates inpatient mortality rate) - Albumin <30 g/dL - INR >1.5 - Altered mental status (GCS<14) - SBP <90 mmHg - Age >65 |
