Acute Upper GI Bleed:

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Acute Upper GI Bleed:. Case 1. 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. - PowerPoint PPT Presentation

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  • Acute Upper GI Bleed:

  • Case 164/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.

  • How important are the colour of his stools?

  • What are the possible causes of his GI bleed?

  • What other physical signs are helpful to determine the cause of GI bleed?

  • Physical examinationThe patient was found to be drowsy, with M5V3E3 (GCS 11/15)BP was 95/70 mm HgHR 110 bpmPeripheries was cold and clammyPulse was feebleSpO2 95%

  • What is the causes of the low GCS?

    What is the significance of the vital signs recorded?

  • You find that he has 8 spider naevis, absence of axillary hair and gross ascites.

    He has a flapping tremor.

    He also has multiple bruising over the extensor surfaces of his arms.

  • What could be the other cause of his low GCS?

    State the stages of hepatic encephalopathy.

  • Suddenly, he develops haemataemesis.Do you insert a Ryles tube? State your reasons for doing so.

  • You check the vital signs again :BP 84/50 mm HgHR 150 bpmGCS M3V2E1 (6/15)SpO2 89%

  • Why has the vital signs worsened?

    Why has he become more hypoxic?

  • What do you do now?List down your approach to stabilizing this patient.

  • Investigation resultsTWC 13.5 Hb 6.0 MCV 80MCH 30Plt 500 Explain the results above.Would you expect hypochromic microcytic anemia?

  • APTT 40PT 15INR 1.8

    What are the possible causes?

  • What other tests to order to elucidate the cause?

  • Urea 28Creat 140Na 130K 3.7

    Explain the results above.

  • TP 60, alb 23ALT 878 ALP 30

    Explain the results.

  • RBS 3.0

    Why?

  • What blood products do you want to give and why?

    What is the target Hb in this patient?

  • List all the problems / diagnosis of this patient.

  • What is the definitive treatment of this patient?

    Are there any drugs which helps reduce bleeding?

  • Are antibiotics needed in this patient?

  • What is the follow up care for this patient?

  • Case 260 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 MCH28PR showed malaena, examination of the abdomen was unremarkable.BP 120/80 mm HgHR 99 bpm

  • What could be the possible causes of his UGIB?

    What investigations would you send?

  • 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?

  • OGDS showed a Forrest IIc ulcer.What does this mean?

  • How can the ulcer be treated endoscopically?

    What drugs should the patient be given?

  • Patient asks you what are the risks for OGDS. What do you say?