Template:UGIB evaluation

Workup

  • 2 large bore IVs
  • Type and cross
  • CBC & serial hemoglobin
  • Chemistry
    • BUN/creatinine >30 suggests UGI if no history of renal failure (increased absorption/digestion of hb)
  • Coags
  • LFTs
  • Fibrinogen
  • Guiac
    • More useful for diagnosing chronic occult bleeding (it could be positive for up to 2 weeks after an acute bleed)
    • False-positive: vitamin C, red meat, methylene blue, bromide preparations, turnips, horseradish
  • ECG (if >40 yo or if suspicious for silent MI, especially from demand ischemia)
  • CXR (if suspect perforation)

NG Lavage Controversy

  • Pros[1]
    • Positive aspirate proves strong evidence for an upper GI source of bleeding
    • Can assess presence of ongoing active bleeding
    • Can prepare patient for endoscopy
  • Cons[1]
    • Uncomfortable
    • Negative aspirate does not conclusively exclude upper GI source
    • Provides useful information in only minority of patients without hematemesis
    • Erythromycin 200mg IV can provide equal endoscopy conditions as lavage[2]
  • 1.0 1.1 Aljebreen AM et al. Nasogastric aspirate predicts high-risk endoscopic lesions in patients with acute upper-GI bleeding. Gastrointest Endosc. 2004;59(2):172-178.
  • Huang ES et al. Impact of nasogastric lavage on outcomes in acute GI bleeding. Gastrointest Endosc. 2011;74(5):971-980.