Difference between revisions of "Gastrointestinal bleeding"

(Created page with "==Workup== ER 0) 2 large bore IV 1) Icon 2) CBC & serial Hb 3) Chem 7 (BUN/Cr >35 suggests UGI if no hx of RF) 4) T&S/T&C 5) Coags (if INR > 1.5 transfuse FFP) 6) ?Guiac...")
 
 
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==Workup==
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*Adults
 
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**[[Upper GI Bleeding]]
 
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**[[Lower GI Bleeding]]
ER
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*[[GI Bleeding (Peds)]]
 
 
0) 2 large bore IV
 
 
 
1) Icon
 
 
 
2) CBC & serial Hb
 
 
 
3) Chem 7 (BUN/Cr >35 suggests UGI if no hx of RF)
 
 
 
4) T&S/T&C
 
 
 
5) Coags (if INR > 1.5 transfuse FFP)
 
 
 
6) ?Guiac
 
 
 
7) LFTs/lipase
 
 
 
8) *CXR if sx perf (diff TTP abd)
 
 
 
9) *ECG (if >50 yo or if suspicious for silent MI)
 
 
 
11) NG lavage (controversial)
 
 
 
12) IVF/blood
 
 
 
13) IV PPI (Protonix 40-80mg x 1, then 8mg/hr)
 
 
 
14) Octreotide (suspected varices: 50mcg bolus, then 25mcg/hr)
 
 
 
15) Ceftriaxone (if e/o ascites; decreases mortality)
 
 
 
16) *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
 
 
 
IBDPolyps
 
 
 
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