Gastro: Upper GI Bleeding: Free MSRA Podcast

🎧MSRA Podcast: UpperGI Bleeding – Emergency Made Easy🚨 A high-yield, rapid-fire breakdown of Upper Gastrointestinal Bleeding(UGIB) — a true emergency you must be ready for in your MSRA exam and in practice.From spotting the bleed to saving the patient, we cover it all. 🧠Essential LearningPoints📌Definition• UGIB = Bleeding proximal to the ligament of Treitz• Typically presentsas haematemesis or melena🧠"Treitzdivides: Upper bleeds above it" 📌Common CausesPeptic ulcer disease (~50%)Oesophageal varices (portal HTN)Mallory-Weiss tear (post-retching tear at GOJ)Gastritis / Duodenitis / OesophagitisGastric malignancy🧠 Mnemonic for causes: "PUVaGoM" = Peptic Ulcer, Varices, Gastritis, Mallory-Weiss 📌Red Flags &Symptoms• Haematemesis (bright red or coffee-groundvomit)• Melena (black, tarry stools)• Shock: Hypotension, tachycardia, confusion• Other: Dizziness, pallor, low urine output🧠 Always ask about NSAID use, alcohol,anticoagulants, retching, and known liver disease 📌Risk Factors• NSAIDs, alcohol,H. pylori, anticoagulants• Chronic liver disease (→ varices)• CKD, older age, socioeconomic factors🧠Risk = Meds + Mucosa+ Medical conditions 📌Initial Management✅ABCDE approach✅ 2x large bore IV cannulas✅ Bloods: FBC, U&Es, LFTs, clotting, Group &Save✅Catheter + Fluidbalance✅ Crossmatch + Consider blood transfusion🧠 If unstable: Follow Massive Haemorrhage Protocol 📌Endoscopy (OGD)🕒 Within 24 hours for most🚨 Urgent if unstable• Diagnostic and therapeutic• Options:Adrenaline injection, clips, banding (varices), thermal coagulation🧠Endoscopy = Eyes +Interventions 📌Variceal Bleeds:Specifics• Terlipressin IV (portal pressure ↓)• Prophylactic antibiotics (↓ SBP risk)• Band ligation (oesophageal) or glue injection (gastric varices)• Consider TIPSS or Sengstaken-Blakemoretube if uncontrolled 📌Non-Variceal Bleeds• PPIs afterendoscopy (e.g. omeprazole IV 72h)• StopNSAIDs/aspirin (unless high cardiac risk)• Treat H. pylori if ulcer diagnosed🧠 PPI = Post-scope only unless high suspicion 📌Scoring Systems📊Glasgow-BlatchfordScore (GBS): Assesses need for admission/intervention📊Rockall Score: Predicts mortality risk🧠 Rockall Mnemonic: ABCDE – Age,BP, Comorbidities, Diagnosis, Endoscopy findings 📌Complications• Rebleeding, hypovolaemicshock, death• Infection (e.g. aspiration pneumonia, SBP)• Endoscopy complications (e.g. perforation,aspiration)• Hepatic encephalopathy in liver patients🧠 Early escalation = better outcomes 📌Prognosis &Outcomes• Overall 10% mortality• Higher ifinpatient bleed (~30%)• Risk of recurrencein older, shocked, comorbid patients🧠 Resuscitate early, scope early, score wisely 📚Upper GI Bleed MSRAResources📝 Revision Notes:https://www.passthemsra.com/topic/upper-gi-bleeding-revision-notes/🧠 Flashcards:https://www.passthemsra.com/topic/upper-gi-bleeding-flashcards/❓ Q&A Accordions:https://www.passthemsra.com/topic/upper-gi-bleeding-accordion-qa-notes/🔥 Rapid Quiz:https://www.passthemsra.com/topic/upper-gi-bleeding-rapid-quiz/🏥 Course Home:https://www.passthemsra.com/courses/gastroenterology-for-the-msra/ Hashtags#MSRA #UpperGIBleed#MSRAFlashcards #MSRAQuiz #GastroMSRA #Varices #OGD #ABCDE #Rockall#GlasgowBlatchford #MassiveGIbleed #MSRAPodcast #MSRAHighYield