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Upper GI bleeding (Definitions (Upper GIT Mouth to duodenum,…

- - - - Use
        Pre-surgery: indication for surgery
        Post-surgery: re-bleed and mortality risk
      - Parameters
        Pre: age, shock (SBP, HR), comorbidity
        Post: diagnosis, signs of bleeding
      - Interpretation
        Pre (max 7): 0=low risk; >6=surgery
        Post (max 11): 0-1=low, 2-4=intermed; 5+=high
    - - Parameters
        Urea, Hb, SBP, HR,
        symptoms (malaena, syncope),
        comorb (liver disease, CCF)
      - Interpretation
        6=likely need intervention
      - Use
        Likelihood of needing medical intervention
- - - - Clotting
        Indication: clotting derangement
        E.g. platelets, FFP, vitamin K
      - PPI
        Indication: high risk patients
        E.g. omeprazole
      - Abx
        Indication: suspected varices
      - ADH agonist
        Indication: suspected varices
        MOA: ADH analogue, reduces BP
    - - Investigative endoscopy
        Varices: banding, sclerotherapy, coagulation, TIPSS
        Ulcers: haemostasis
      - Open surgery
        Indication: severe bleeding, uncontrolled bleed