Pathology: Bleeding originating proximal to the ligament of Treitz(suspensory muscle of duodenum, inserts into distal duodenum) in the GI tract.
Aetiology: Oesophagus: Ulceration (aspirin, NSAIDs), oesophageal varices, malignancy,
Mallory-Weisstear
Gastric: Ulceration, adenocarcinoma,varices, angiodysplasia
Duodenum: Ulceration, varices, malignancy,angiodysplasia
Symptoms: Oesophageal:dysphagia, odynophagia, dyspepsia.
Gastric Ulcer:abdominal pain, worsens on eating
Duodenal Ulcer: abdominal pain, improves on eating
Signs: Haematemesis,malaena, shock
Stigmata of liver disease (Varicealbleeding): Jaundice, ascites, spider naevi, caput
medusae, splenomegaly
Investigations: Bloods: FBC - Anaemia, U&E showing increased urea (protein meal fromblood),
Clotting screen and Group and Save
OGD: Locatesource of bleeding
CTAngiography: Locate source of bleeding
Treatment: Medical: PPI, correct coagulopathy, blood transfusion
OGD: Treat ulcers to stop bleeding
CTAngiography: Embolisation of bleeding vessel
Surgery: If refractory bleeding
Complications: Hypovolaemic shock, renalfailure, death
Prognosis: The Rockall score is used to risk stratify mortality and rebleeding risk.The pre- endoscopy score is often used to calculate risks. Score > 3 is a highrisk patient.
Table 3.1 Rockall Score
Age
< 60
60-79
> 80
Shock
No shock
HR > 100
SBP > 100
SBP < 100
Co-morbidity
Nil Major
CCF, IHD,
major morbidity
Renal failure, liver failure, metastatic cancer
Diagnosis
Mallory-Weiss
Evidence of bleeding
None
Blood, adherent clot, spurting vessel
