GASTROENTEROLOGY

Take a focused history from a (stable) patient presenting with upper GI bleeding. Include presenting complaint, past medical history, drug history and social history.

Consider:

• What are the different ways in which upper GI bleed patients present?
• What are the main causes of upper GI bleeding? From the history you have taken, what do you think is the most likely cause and why? Give two features from the history and two from examination that make each more likely.

If appropriate, examine the patient using a structured ABCDE approach. Following this, document your findings in a table similar to the one below:

Assessment Treatment

Airway

Breathing

Circulation

Disability

Exposure

Highlight or circle any concerning features on examination.

Review the notes for the patient you have seen. Calculate a risk score (e.g. Glasgow Blatchford or Rockall Score). You will need to access the patient's blood results and initial examination/assessment findings.

You may want to consider:

• What are the key differences between the two scoring systems?
• What might be the pros and cons of each?
• What does the Glasgow Blatchford or Rockall Score tell you about the patient?

Document your specific management of non-variceal upper GI bleeds.

Consider:

• Timing of endoscopy
• Role of proton pump inhibitors pre-endoscopy

Find a mock consent form and complete it with respect to the patient you have seen. Consider the indication and risks of the procedure. If possible, practice taking consent on a friend or colleague.

Imagine that the patient the student(s) have seen underwent an endoscopy that confirmed a duodenal ulcer. Find the local guidelines on proton pump therapy infusions and prescribe it accordingly on a drug chart.

1. https://www.mdcalc.com/glasgow-blatchford-bleeding-score-gbs
2. https://geekymedics.com/acute-management-of-upper-gi-bleeding/