Presentation on theme: "Tad Kim, M.D. Connie Lee, M.D. Michael Hong, M.D."— Presentation transcript:
1Tad Kim, M.D. Connie Lee, M.D. Michael Hong, M.D. Upper GI HemorrhageTad Kim, M.D.Connie Lee, M.D.Michael Hong, M.D.
2Definitions Enzymatic breakdown UGIH = proximal to ligament of Treitz Hematemesis = vomiting blood - bright red or coffee-ground (typically UGI source)Melena = black tarry stool (often UGI)Enzymatic breakdownHematochezia = bloody stool (LGI > UGI)Blood as cathartic agentOccult blood = UGI or LGI source
3DDx Peptic Ulcer Disease (PUD) >50% cases Gastritis / Duodenitis (15-30%)Subset due to NSAID useEsophageal varices from portal hypertension (10-20%)Gastric varicesMallory-Weiss tears at GE junction (5%)Esophagitis (3-5%)Malignancy (3%)Dieulafoy’s lesion (1-3%)Nasopharyngeal bleed – swallowed bloodOther- aortoenteric fistula, angiodysplasia, Crohn’s, hemobilia, hemosuccus pancreaticus, AVM, watermelon stomachLGI: diverticulosis, hemorrhoids, anal fissure, UC/Crohn’s, Meckel’s,
4Initial Evaluation Evaluate ABCs/PE: Can the pt protect his airway? Is the pt hemodynamically unstable?Does the pt have adequate IV access, Foley, NGT?Resuscitate as appropriateOrders: NPO, IVF, NGT to LCWS, Foley, HOB>30, continuous pulse oximetry & telemetryLabs: type & cross, CBC, INR/PT/PTT, BMP, LFTsAdditional question to ask yourself:Does the pt require a higher level of care?
5H&PRisk factors: age, oral anticoagulant use, h/o prior GIB, PUD, NSAID use, alcohol/tobacco use, liver disease / portal HTN, burn/trauma, severe vomiting, h/o H. pylori, GI instrumentation, AAA repairHistory: OPQRST, PMHx, PSHx, Meds, ALL, SHx.Symptoms: none postural hypotension, exertional dyspneaCoffee ground emesis (UGI)PE: remember to examine for signs of cirrhosis & portal HTN (ascites, caput medusa, rectal varices)Tests: T&C, CBC, coags, BMP, LFT, CXR/KUB
6Management Assess magnitude of hemorrhage Place 2 large-bore IV, volume resuscitation w/ isotonic IVF. Be prepared to transfuse blood.Place NGT & lavage, place FoleyNG lavage can identify UGIMonitor for continued blood lossStart proton pump inhibitor (PPI) infusionFor varices: start octreotide infusionReduces portal pressure, vasoconstricts