Difference between revisions of "Gastrointestinal bleeding"

 
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==Workup==
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*Adults
===ER===
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**[[Upper GI Bleeding]]
# 2 large bore IV
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**[[Lower GI Bleeding]]
# Icon
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*[[GI Bleeding (Peds)]]
# CBC & serial Hb
 
# Chem 7 (BUN/Cr >35 suggests UGI if no hx of RF)
 
# T&S/T&C
 
# Coags (if INR > 1.5 transfuse FFP)
 
# ?Guiac
 
# LFTs/lipase
 
# ?CXR if sx perf (diff TTP abd)
 
# ?ECG (if >50 yo or if suspicious for silent MI)
 
# NG lavage (controversial)
 
# IVF/blood
 
# IV PPI (Protonix 40-80mg x 1, then 8mg/hr)
 
# Octreotide (suspected varices: 50mcg bolus, then 25mcg/hr)
 
# Ceftriaxone (if e/o ascites; decreases mortality)
 
# ?Consider vasopressin/sengstaken-blakemore tube if no access to endoscopy
 
 
 
If aortic graft --> immed surg consult
 
 
 
===Consider===
 
#Proctoscopy (22cm from anal verge)
 
#Sigmoidoscopy (60cm from anal verge)
 
#Angiography (requries arterial bledding >0.5cc/min)
 
#CT angio
 
 
 
==DDX==
 
===Adult===
 
#UGIB
 
##PUD (Gastric 21%, Duodenal 24%)
 
##Gastritis 23%
 
##Esophagitis/Duodenitis 6%
 
##Varicies
 
##Mallory-Weiss <15%
 
##Boerhaave's
 
##Dieulafoy lesion
 
##Angiodysplasia
 
##Hemobilia
 
##Aortoenteric fistula
 
#LGIB
 
#Upper GI bleed
 
#Diverticulosis (painless, voluminous)
 
#Infectious (virus, bacteria, parasites, C. dif)
 
#Ischemic Colitis 3-12% (acute onset; 90% > 70yo)
 
#IBD (fistula-in-ano)
 
#Mesenteric Vascular Insufficiency (abd pain out of proportion to PE)
 
#Angiodysplasia
 
#Cancer/polyps
 
#Rectal dz
 
#Hemorrhoids
 
##External (below pectinate); Internal (above)
 
#Ulcer (HIV, syphilis, STDs)
 
#Fissures (painful defecation)
 
#Abscess, prolapse, proctitis, impaction
 
 
 
===Peds===
 
#UGIB
 
##Esophagitis
 
##Gastritis
 
##Ulcer
 
##Esophageal varices
 
##Mallory-Weiss
 
#LGIB
 
##Anal fissure
 
##Infectious colitis
 
##IBD
 
##Polyps
 
##Intussusception
 
 
 
==Disposition==
 
Blatchford score
 
 
 
Rockall score
 
 
 
===Home (very low risk)===
 
#No comorbid dz
 
#Normal vitals
 
#Norma/trace pos guiac
 
#Normal/near-normal Hb
 
#Home support
 
#F/U within 24hrs
 
 
 
===Ward/Stable (low risk)===
 
#Age <60
 
#Initial SBP >100
 
#Normal vitals x 1hr
 
#No transfusion req
 
#No major comorbid
 
#No liver dz
 
 
 
===ICU===
 
#Normal or dec Hct
 
#Blood in NG doesn't clear
 
#SBP<100, HR>100
 
#Gauaic +/- stool
 
 
 
==False Positive Guaiac==
 
#Red fruits and meats
 
##(Bananas, turnips, broccoli)
 
#Methylene blue
 
#Chlorophyll
 
#Iodide
 
#Cupric sulfate
 
#Bromide
 
#Iron (causes GI bleed by irritation)
 
 
 
==Source ==
 
3/12/06 DONALDSON (adapted from Rosen), Kaji
 
  
 
[[Category:GI]]
 
[[Category:GI]]
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[[Category:Symptoms]]

Latest revision as of 23:10, 28 November 2019