Not normally difficult to spot, but look for it in unexplained anaemia, or collapse.
Questions
- Is it VARICEAL? Mortality 35%, so is an emergency whatever the GBS is.
- Non-Variceal what’s the GBS? will help guide treatment
Anyone being admitted should be brought to HRI
Emergency Endoscopy is arranged by Med Reg
Causes
- Variceal – 10% of Upper GI Bleeds (35% mort.) Hx indicating liver failure
- Ulcers – Epigastric pains, reflux, dysphagia
- Mallory-Wiess – Retching/coughing/vomiting prior to bleed
- Malignancy – Often painless, weight loss, dysphagia
Actions for ALL
- Full Observations
- Cannula – large (x2 if unwell)
- Bloods: FBC/U&E/LFT/Coag/G&S
Consider for ALL
- Correct Anticoagulants: Discuss with Haematologist
- Massive Transfusion Pathway: Refer to MTP guide
Consider for Variceal
- Terlipressin 2mg IV Bolus – Mortality Risk Reduction(RR) 34%
- IV Antibiotics (Antibiotic Page) – Mort RR 27%, Sepsis RR 60%
Glasgow-Blatchford Score
| Urea level | Haemoglobin [Male] | Haemoglobin [Female] | Systolic BP | Other | |||||
|---|---|---|---|---|---|---|---|---|---|
| ≥6·5 <8·0 | 2 | ≥120 <130 | 1 | ≥100 <120 | 1 | 100–109 | 1 | Pulse ≥100 bpm | 1 |
| ≥8·0 <10·0 | 3 | ≥100 <120 | 3 | <100 | 6 | 90–99 | 2 | Melaena | 1 |
| ≥10·0 <25·0 | 4 | <100 | 6 | <90 | 3 | Syncope | 2 | ||
| ≥25 | 6 | Hepatic disease | 2 | ||||||
| Cardiac failure | 2 | ||||||||
- 0 – Suitable for Discharge (NICE)
- 1-2 – Suitable for medical review potential discharge
- >5 – High risk >50% will need intervention (Med Reg must be informed)
Significant UGIB
- Ongoing bleed, Haemodynamic instability, GBS >5, OR high suspicion of variceal bleed
- Ensure Senior involved
- Should be transferred to HRI (ED/AMU) Urgent assessment by Med Reg
- Med Reg to liaise with Emergency Endoscopy + Surgical team
Emergency Endoscopist will decide: if out of hours likely to happen in theatre.
Sengstaken tube
- Consider if endoscopy required but not possible
- Only buys time; stops 90%, but will re-bleed within 24hr
- Require intubation prior to insertion
- Insert to 60cm
- Inflate gastric balloon ONLY – 250ml/Resistance
- Traction attach 1000ml bag and hang over drip stand
PDF:gi bleed
