- haematemesis (=vomiting blood)
- coffee ground vomiting or
- malaena (=black, tar-like motions)
Commonest causes of upper GI bleeds are:
- 35% duodenal ulcers
- 20% gastric ulcers
- 18% gastric erosins
- 10% Mallory-Weiss tear
Rarer causes of GI bleeds include:
- variceal haemorrhage
- aorto-enteric fistula
- Meckel's diverticulum
- Peutz-Jeghers syndrome
Risk of rebleeding and mortality from upper GI bleeds is calculated using the Rockall score.
Pre-endoscopy Rockall score is calculated based on:
- age
- 0pt <60yrs
- 1pt 60-79
- 2pts >80
- degree of shock
- 0pt: BP >100 sys and HR <100
- 1pt: BP >100 sys but HR >100
- 2pts: BP <100 sys
- co-morbidities
- 0pt: none
- 1pt: heart problems
- 2pts: liver/renal failure
- 3pts: mets
Mortality is roughly:
- 1 in 20 with 2 pts
- 1 in 10 with 3 points
- 1 in 4 with 4 points
- 1 in 2 with 7 points
Post endoscopy mortality is calculated based on the initial score, the diagnosis and the signs of haemorrhage seen.
Below is a summary of the Rockall score from the SIGN guidelines:
Management of upper GI bleeds is:
- classic ABC resuscitation
- if cause suspected to be variceal haemorrhage: IV terlipressin 2mg then 2mg/4hr
- urgent endoscopy
- surgery if endoscopy unsuccessful
- if cause is ulcer: omeprazole after endoscopy
- if cause is variceal haemorrhage: consider transjugular intrahepatic portosystemic shunt to prevent rebleeding (note: nearly 25% of people with a TIPS get hepatic encephalopathy)
Now to Meckel's diverticulum...
