GASTROENTEROLOGY
GASTROENTEROLOGY
Embedded Files
UPPER GASTROINTESTINAL BLEEDING
UPPER GASTROINTESTINAL BLEEDING
Introduction
5 minIntroduction
Introduce yourself and the group
Provide rationale for the session and relevance to clinical practice
Outline learning objectives:
- Take a focused history from a patient presenting with upper GI bleeding
- Understand key priorities in resuscitation of an unstable patient with an upper GI bleed
- Be aware of risk stratification tools for upper GI bleeding
- Understand the ongoing management of upper GI bleeding
Explain structure of session
Total time:
60 minNumber of students:
1-5Grade of students:
3rd to 5th year medical studentsCreated by:
Dr Dan O'NeillUploaded:
17th September 2019Last updated:
17th September 2019Resources needed for this session:
Resources needed for this session:
Consent form, prescription chart, pen, paper
Resources linked to this session:
Resources linked to this session:
None
Activity 1: History Taking
10 minActivity 1: History Taking
Ask the student(s) to take a focused history from a (stable) patient presenting with upper GI bleeding. Include presenting complaint, past medical history, drug history and social history.
This can be observed if capacity of tutor allows.
Activity 2: Case-Based Discussion
10 minActivity 2: Case-Based Discussion
Ask student to present their history. Feedback on presentation style (max 1 min).
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?
Activity 3: Initial Assessment
15 minActivity 3: Initial Assessment
Ask the student(s) to examine the patient using a structured ABCDE approach. Following this, debrief and discuss:
- How would you assess and begin basic management of this patient?
- What findings in your assessment might suggest this patient is more unwell?
Remember to discuss appropriate investigations and interventions at each stage (e.g. securing IV and obtaining a venous blood gas for initial Hb measurement, G&S/x-match under circulation).
Activity 4: Risk Stratification
5 minActivity 4: Risk Stratification
Ask the student(s) to calculate a risk score for the patient they have seen (e.g. Glasgow Blatchford or Rockall Score). They will need to access the patient's blood results and initial examination/assessment findings. The QR code opposite links to the mdcalc Glasgow Blatchford calculator.
You may want to discuss:
- What are the key differences between the two scoring systems?
- What might be the pros and cons of each?
- What does the Glasgow Blatchford/Rockall Score tell you about the patient?
Activity 5: Further Management
15 minActivity 5: Further Management
Discuss the specific management of non-variceal upper GI bleeds. Consider:
- Timing of endoscopy
- Role of proton pump inhibitors pre-endoscopy
Ask the student(s) to find a consent form and complete it with respect to the patient they have seen. Consider the indication and risks of the procedure. If time, they may want to practice taking consent on each other.
Imagine that the patient the student(s) have seen underwent an endoscopy that confirmed a duodenal ulcer.
Ask the student(s) to find the local guidelines on proton pump therapy infusions and prescribe it accordingly on a drug chart.
Summary and Feedback
5 minSummary and Feedback
Questions
Identify and summarise key learning points (key three points if possible)
Feedback to student – highlight further learning needs
Feedback for teacher - ask students to provide feedback using the QR code opposite
Close
References and Further Reading
References and Further Reading
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