GASTRO/GENSURG
GASTROINTESTINAL BLEEDING
PromptUPPER GI BLEEDING/VARICES
Response
PromptInvestigations in suspected variceal bleeding
ResponseVBG - assess degree of hypoperfusion - lactate/base excess
HB - Guide packed cell replacement
Coags - High chance of liver disease - will guide FFP therapy
Fibrinogen/Ca - also will require replacement to manage coagulopathy
BSL - in liver failure may be low - replace if needed
ROTEM
HB - Guide packed cell replacement
Coags - High chance of liver disease - will guide FFP therapy
Fibrinogen/Ca - also will require replacement to manage coagulopathy
BSL - in liver failure may be low - replace if needed
ROTEM
PromptManagement of UGI bleeding
ResponseResuscitation
IV octreotide - 50 mic bolus then 50 mics/hr (alternative: Terlipressin 2 mg Q4H or Somatostatin 250 mics >> 250 mics/hr)
(Vitamin K/FFP to treat coagulopathy)
IV antibiotics for gram neg cover - Ceftriaxone 1g
(Alcohol withdrawal benzo’s/thiamine)
Referral for endscopy - banding/injection of cyanoacrylate
Blakemore tube
Good stuff on ACI website
- Fluids/MTP (based on question)
- A+B - assure airway is clear, suctioning if required, be prepared for intubation (difficult tube) aim sats >95%)
IV octreotide - 50 mic bolus then 50 mics/hr (alternative: Terlipressin 2 mg Q4H or Somatostatin 250 mics >> 250 mics/hr)
(Vitamin K/FFP to treat coagulopathy)
IV antibiotics for gram neg cover - Ceftriaxone 1g
(Alcohol withdrawal benzo’s/thiamine)
Referral for endscopy - banding/injection of cyanoacrylate
Blakemore tube
Good stuff on ACI website
PromptLOWER GI BLEEDING
Response
PromptDifferentials for Lowe GI bleeding
ResponseAortoenteric fistula
Supratheraputic anticoagulation
Embolic mesenteric ischaemia
Angiodysplasia
Tumours/polyps
Haemorrhoids
Inflammatory bowel disease
Diverticular disease (although apparently it was wrong in my trial exam?)
Supratheraputic anticoagulation
Embolic mesenteric ischaemia
Angiodysplasia
Tumours/polyps
Haemorrhoids
Inflammatory bowel disease
Diverticular disease (although apparently it was wrong in my trial exam?)
PromptInvestigations in Lower GI Bleeding
ResponseCoags/Rotem - assess coagulopathy secondary to blood loss/guide replacement
Thrombin time - Assess coagulopathy due to Dabigatran (in stem) ? antidote or enhanced elimination
Blood cultures - identification of bacteria and sensitivity will guide antibiotics selection and duration
CT angiogram of abdomen
Thrombin time - Assess coagulopathy due to Dabigatran (in stem) ? antidote or enhanced elimination
Blood cultures - identification of bacteria and sensitivity will guide antibiotics selection and duration
CT angiogram of abdomen
- Define aortoenteric fistula
- Confirm mesenteric ischaemia
- Establish other cause for bleeding (eg: Tumour requiring resection/embolisation)