Acute Upper GI Bleed Case 1 l l
Acute Upper GI Bleed:
Case 1 l l 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.
l How important are the colour of his stools?
l What are the possible causes of his GI bleed?
l What other physical signs are helpful to determine the cause of GI bleed?
Physical examination l l l The patient was found to be drowsy, with M 5 V 3 E 3 (GCS 11/15) BP was 95/70 mm Hg HR 110 bpm Peripheries was cold and clammy Pulse was feeble Sp. O 2 95%
l What is the causes of the low GCS? l What is the significance of the vital signs recorded?
l You find that he has 8 spider naevis, absence of axillary hair and gross ascites. l He has a flapping tremor. l He also has multiple bruising over the extensor surfaces of his arms.
l What could be the other cause of his low GCS? l State the stages of hepatic encephalopathy.
l l Suddenly, he develops haemataemesis. Do you insert a Ryle’s tube? State your reasons for doing so.
l You check the vital signs again : – – BP 84/50 mm Hg HR 150 bpm GCS M 3 V 2 E 1 (6/15) Sp. O 2 89%
l Why has the vital signs worsened? l Why has he become more hypoxic?
l l What do you do now? List down your approach to stabilizing this patient.
Investigation results l l l l TWC 13. 5 Hb 6. 0 MCV 80 MCH 30 Plt 500 Explain the results above. Would you expect hypochromic microcytic anemia?
l APTT 40 PT 15 INR 1. 8 l What are the possible causes? l l
l What other tests to order to elucidate the cause?
l Urea 28 Creat 140 Na 130 K 3. 7 l Explain the results above. l l l
l TP 60, alb 23 ALT 878 ALP 30 l Explain the results. l l
l RBS 3. 0 l Why?
l What blood products do you want to give and why? l What is the target Hb in this patient?
l List all the problems / diagnosis of this patient.
l What is the definitive treatment of this patient? l Are there any drugs which helps reduce bleeding?
l Are antibiotics needed in this patient?
l What is the follow up care for this patient?
Case 2 l l l 60 year old man presents with 1 week history of malaena and shortness of breath? On examination he his pale and cachexic. Hb 9. 0 g/d. L MCV 60 MCH 28 PR showed malaena, examination of the abdomen was unremarkable. BP 120/80 mm Hg HR 99 bpm
l What could be the possible causes of his UGIB? l What investigations would you send?
l l 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?
l l OGDS showed a Forrest IIc ulcer. What does this mean?
l How can the ulcer be treated endoscopically? l What drugs should the patient be given?
l Patient asks you what are the risks for OGDS. What do you say?
- Slides: 30
