Division between upper and lower GIT - lig of treitz

Upper GI bleed:

Most commonly due to varices or PID

Features:

• haematemesis
  • the most common presenting feature
  • often bright red but may sometimes be described as 'coffee gound'
• melena
  • the passage of altered blood per rectum
  • typically black and 'tarry'
• features associated with a particular diagnosis e,g,
  • oesophageal varices: stigmata of chronic liver disease
  • peptic ulcer disease: abdominal pain
• a raised urea may be seen due to the 'protein meal' of the blood

Management

Risk assessment

• the Glasgow-Blatchford score at first assessment
  • helps clinicians decide whether patient patients can be managed as outpatients or not
  • Patients with a Blatchford score of 0 may be considered for early discharge.
• the Rockall score is used after endoscopy
  • provides a percentage risk of rebleeding and mortality
  • includes age, features of shock, co-morbidities, aetiology of bleeding and endoscopic stigmata of recent haemorrhage

Resuscitation

• ABC, wide-bore intravenous access
• platelet transfusion if actively bleeding platelet count of less than 50 x 10*9/litre
• fresh frozen plasma to patients who have either a fibrinogen level of less than 1 g/litre, or a prothrombin time (international normalised ratio) or activated partial thromboplastin time greater than 1.5 times normal
• prothrombin complex concentrate to patients who are taking warfarin and actively bleeding