Acute Upper GI Bleed:

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Acute Upper GI Bleed:
Case 1
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64/C/M presented to the A&E with c/o
SOBOE, giddiness and lethargy.
He gives a history of passing out black tarry
stools yesterday.
He has been taking diclofenac sodium
regularly due to bilateral knee pains.
He has also drinking alcohol regularly, i.e. 2
large bottle of beers daily.
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How important are the colour of his stools?
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What are the possible causes of his GI
bleed?
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What other physical signs are helpful to
determine the cause of GI bleed?
Physical examination
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The patient was found to be drowsy, with
M5V3E3 (GCS 11/15)
BP was 95/70 mm Hg
HR 110 bpm
Peripheries was cold and clammy
Pulse was feeble
SpO2 95%
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What is the causes of the low GCS?
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What is the significance of the vital signs
recorded?
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You find that he has 8 spider naevis,
absence of axillary hair and gross ascites.
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He has a flapping tremor.
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He also has multiple bruising over the
extensor surfaces of his arms.
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What could be the other cause of his low
GCS?
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State the stages of hepatic encephalopathy.
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Suddenly, he develops haemataemesis.
Do you insert a Ryle’s tube? State your
reasons for doing so.
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You check the vital signs again :
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BP 84/50 mm Hg
HR 150 bpm
GCS M3V2E1 (6/15)
SpO2 89%
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Why has the vital signs worsened?
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Why has he become more hypoxic?
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What do you do now?
List down your approach to stabilizing this
patient.
Investigation results
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TWC 13.5
Hb 6.0
MCV 80
MCH 30
Plt 500
Explain the results above.
Would you expect hypochromic microcytic
anemia?
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APTT 40
PT 15
INR 1.8
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What are the possible causes?
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What other tests to order to elucidate the
cause?
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Urea 28
Creat 140
Na 130
K 3.7
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Explain the results above.
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TP 60, alb 23
ALT 878
ALP 30
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Explain the results.
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RBS 3.0
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Why?
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What blood products do you want to give and
why?
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What is the target Hb in this patient?
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List all the problems / diagnosis of this
patient.
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What is the definitive treatment of this
patient?
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Are there any drugs which helps reduce
bleeding?
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Are antibiotics needed in this patient?
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What is the follow up care for this patient?
Case 2
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60 year old man presents with 1 week history
of malaena and shortness of breath?
On examination he his pale and cachexic.
Hb 9.0g/dL MCV 60 MCH28
PR showed malaena, examination of the
abdomen was unremarkable.
BP 120/80 mm Hg
HR 99 bpm
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What could be the possible causes of his
UGIB?
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What investigations would you send?
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Would you transfuse him with blood?
What are the indications for blood
transfusion?
How fast would you transfuse the blood?
Do you need to give IV Frusemide as well?
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OGDS showed a Forrest IIc ulcer.
What does this mean?
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How can the ulcer be treated
endoscopically?
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What drugs should the patient be given?
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Patient asks you what are the risks for
OGDS. What do you say?
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