GI Bleeding

GI bleeding 1

Acute management:

  • Bolus of NS\RL
  • CBC:
    • HCT: if < 30 in an elderly pt w\ heart ds -> give PRBC
    • Platelet: if < 50,000 -> transfuse platelets
    • ↑ PT\ INR > 1.5 -> give FFP
  • Know etiology:
    • NG tube: to know if UGI\LGI
    • Endoscopy

 

  • If liver ds\alcohol\vomiting blood -> this is a variceal UGI bleed -> add octreotide
    • —› if continued: do endoscopic banding
    • —› if continued: do TIPS (trans jugular intrahepatic portosystemic shunting) -> decompresses portal HTN. Major complication of TIPS? Hepatic encephalopathy

 

  • Ulcers -> cauterize, epinephrine, clipping
  • If the cause of GI bleeding is ulcers or gastritis -> give PPI by infusion ‘works acutely’ (not H2 blockers!)

 

  • When pt is better\stable -> give B-blockers: propranolol, nadolol (prophylactic; prevent next GI bleed)

GI bleeding 2 

 

Random notes:

  • How do pts die from GI bleeding? Ischemic heart! (do ECG)
  • Platelet count of 20,000 -> risk of spontaneous bleeding
  • FFP works immediately, unlike vitamin K
  • Don’t treat H. pylori (evidence by positive serology, breath test, stool Ag, or biopsy) unless there is ulcers or gastritis
  • Amount of blood loss in Heme\guaiac positive brown stool = coffee ground emesis = 5-10 mL
  • Amount of blood loss in melena = 100 mL
  • If pulse > 100 + SBP < 100 -> means 30% volume loss (while sitting)
  • Orthostasis: change in pulse > 10 + SBP > 20 from sitting to standing = means 15-20% volume loss

 


Download the PDF version: here


References:

  • Kaplan step 2 videos

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this:
search previous next tag category expand menu location phone mail time cart zoom edit close