Gastroenterology – Upper GI Bleeding: By John Kargbo M.D.
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Gastroenterology – Upper GI Bleeding: What You Need to Know
Whiteboard Animation Transcript
with John Kargbo, MD
https://medskl.com/Module/Index/uppergibleeding
UGI bleeding is most likely, when a patient presents with hematemesis, coffee ground emesis,
or melena.
Once UGI bleed is suspected, hemodynamic stability must be assessed. Unstable patients with low blood pressure, tachycardia, or orthostatic changes, should be immediately resuscitated.
Assess ABCs, insert two large bore IVs, and give a bolus of 12L of normal saline, and monitor continuously. Consider rapid sequence intubation to prevent aspiration of blood with profuse hematemesis and altered mental status. If hypotension persists despite fluid boluses, transfuse with blood and correct coagulopathy.
Intravenous proton pump inhibitors are started if suspected PUD. IV Octreotide is used for variceal bleeds.
• Peptic ulcer disease is the most common cause of UGI bleeding. Think about PUD in a patient with epigastric discomfort and a history of NSAID use.
• Think about variceal bleeds in a patient with portal hypertension and stigmata of chronic liver disease.
• A history of vomiting, retching followed by hematemesis suggest Mallory Weiss tear.
• Patients with acute abdomen and signs of peritonitis, should be imaged to rule out perforation along with prompt surgical consultation.
• Suspect aortoenteric fistula with a history of aortic graft, as emergency endoscopy is indicated and surgery, if diagnosed.
With appropriate resuscitation, 80% of UGI bleeds will stop spontaneously.Variceal bleeds however, have the highest mortality rate and early endoscopic banding is recommended.
Gastrointestinal Bleeding: General Surgery
MBBS General Surgery Lectures.
النزف الهضمي GI Bleeding
References:
Toronto notes 2018
UpToDate®
Acute Gastrointestinal Bleeding causes,features,diagnosis and treatment
Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum.
When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.
Small amounts of bleeding over a long time may cause irondeficiency anemia resulting in feeling tired or heartrelated chest pain
Other symptoms may include abdominal pain, shortness of breath, pale skin, or passing out.
Sometimes in those with small amounts of bleeding no symptoms may be present.
Bleeding is typically divided into two main types: upper gastrointestinal bleeding and lower gastrointestinal bleeding.
Causes of upper GI bleeds include: peptic ulcer disease, esophageal varices due to liver cirrhosis and cancer, among others.
Causes of lower GI bleeds include: hemorrhoids, cancer, and inflammatory bowel disease among others.
Diagnosis typically begins with a medical history and physical examination, along with blood tests.
Small amounts of bleeding may be detected by fecal occult blood test.
Endoscopy of the lower and upper gastrointestinal tract may locate the area of bleeding
Medical imaging may be useful in cases that are not clear.
Initial treatment focuses on resuscitation which may include intravenous fluids and blood transfusions.
Often blood transfusions are not recommended unless the hemoglobin is less than 70 or 80 g/L.
Treatment with proton pump inhibitors, octreotide, and antibiotics may be considered in certain cases.
If other measures are not effective, an esophageal balloon may be attempted in those with presumed esophageal varices
Endoscopy of the esophagus, stomach, and duodenum or endoscopy of the large bowel are generally recommended within 24 hours and may allow treatment as well as diagnosis.
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Gastrointestinal Bleeding (GI Bleed) – Emergency Medicine | Lecturio
This video “Gastrointestinal Bleeding (GI Bleed)” is part of the Lecturio course “Emergency Medicine” ► WATCH the complete course on http://lectur.io/gibleed
► LEARN ABOUT:
Case Study: GI Bleeding
Division of Gastrointestinal Bleeding
Causes of Upper GI Bleed
Causes of Lower GI Bleed
Comparison of upper and lower GI Bleed
How to examine GI Bleed?
Signs and symptoms of GI Bleeding
Thinking about the differential: could blood be coming from elsewhere?
GI Bleed Keywords
► THE PROF:
As an assistant professor in the Department of Emergency Medicine at the Johns Hopkins University School of Medicine, Sharon Bord, M.D. knows how to teach important skills to students. She is a member of the Committee of Emergency Medicine Residency Directors and Clerkship Directors in Emergency Medicine and on the editorial board for a board review question book.
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