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Q1: UGIB vs LGIB (2 min)
"How do you distinguish upper from lower GI bleeding clinically?"
- Haematemesis / coffee-ground vomiting → UGIB
- Melaena usually UGIB (can be right colon slow bleed)
- Bright red haematochezia usually LGIB, but can be brisk UGIB
- NG aspirate not mandatory; endoscopy decisions are clinical
Q2: Glasgow-Blatchford (2 min)
"What is GBS used for, and what does a score of 0 mean?"
- Pre-endoscopy score using urea, Hb, SBP, pulse, melaena, syncope, liver disease, heart failure
- Stratifies need for admission/intervention
- GBS 0 identifies very low-risk patients who may be managed as outpatients with planned early OGD
Q3: Forrest classification (2 min)
"Which Forrest classes need endoscopic therapy?"
- Ia spurting, Ib oozing, IIa visible vessel — yes
- IIb adherent clot — often after removal
- IIc flat spot, III clean base — medical management, low rebleed risk
Q4: Restrictive transfusion (2 min)
"What is the evidence-based Hb threshold in acute UGIB?"
- Restrictive threshold 7 g/dL improved outcomes vs liberal 9 g/dL (Villanueva)
- Higher target if massive ongoing bleed or significant cardiac disease
Q5: Variceal bundle (3 min)
"List the variceal haemorrhage bundle."
- Resuscitate + airway protection
- Restrictive transfusion
- Terlipressin (or octreotide)
- Antibiotics
- Early endoscopy with banding
- Rescue tamponade/TIPS if refractory
- Later secondary prophylaxis (non-selective beta-blocker + repeat banding)