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GI Bleeding

GI Bleeding. Tintinalli Chapter 74. GI Bleeding. Poor prognostic factors Hemodynamic instability Repeated hematemesis or hematochezia Failure to clear with gastric lavage Older than 60 Coexistent organ system disease. Upper GI Bleed (above ligament of Treitz) Peptic ulcer disease 60%

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GI Bleeding

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  1. GI Bleeding Tintinalli Chapter 74

  2. GI Bleeding • Poor prognostic factors • Hemodynamic instability • Repeated hematemesis or hematochezia • Failure to clear with gastric lavage • Older than 60 • Coexistent organ system disease

  3. Upper GI Bleed (above ligament of Treitz) Peptic ulcer disease 60% Erosive gastritis / esophagitis / duodenitis 15% Esophageal / gastric varicies Pathophysiology

  4. Mallory-Weiss syndrome Other Stress ulcer AV malformation Malignancy Pathophysiology

  5. Lower GI Bleed Diverticulosis Angiodysplasia Other Carcinoma Hemorrhoids Inflammatory bowel disease Polyps Infectious gastroenteritis

  6. History Physical Vitals Spider angiomata Palmar erythema Jaundice Petechiae / purpura Careful ENT exam Abdominal exam Rectal exam Diagnosis

  7. Laboratory data CBC CMP Type and cross Coagulation studies EKG Diagnosis

  8. Diagnostic studies Plain Abd / Chest films are of no value Neither are barium studies Barium also limits endoscopy and angiography Angiography – bleeding rate > 0.5-2.0 ml / min Scintigraphy – bleeding rate 0.1 ml / min Endoscopy Diagnosis

  9. ABCs first 2 large IVs with NS Blood if clinically indicated NG tube in all patients with significant GI bleeding regardless of the source. Treatment

  10. Room temp irrigation of stomach if clots or blood returned. No benefit from cold water Endoscopy Diagnostic and therapeutic Treatment

  11. Drugs Somatostatin / octreotide Octreotide 50 ug iv bolus then 50 ug q 8-24 hrs Longer acting than somatostatin As effective as sclerotherapy for varices Vasopressin Multiple adverse reactions. Not as effective as octreotide PPIs Treatment

  12. Other Sengstaken-Blakemore tube Surgery Treatment

  13. Disposition Admission Significant bleeding Unstable vitals High risk variables HcT < 30% Initial SBP <100 Red blood in NG lavage History of cirrhosis (or ascites on exam) History of vomiting red blood Discharge Require endoscopy for risk stratification first. Treatment

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