Upper gastrointestinal bleed - Revision history

Aidan: /* Etiology */

2020-08-02T14:40:46Z

Etiology

← Older revision		Revision as of 14:40, 2 August 2020
Line 1:		Line 1:
	== Etiology ==		==Etiology==

	* Bleeding peptic ulcer		*Bleeding [[peptic ulcer]]
	** Duodenal ulcer (20-30%)		**Duodenal ulcer (20-30%)
	** Gastric ulcer (10-20%)		**Gastric ulcer (10-20%)
	* Gastric or duodenal erosion (20-30%)		*Gastric or duodenal erosion (20-30%)
	* Bleeding esophageal varices (15-20%)		*Bleeding [[esophageal varices]] (15-20%)
	* Other		*Other
	** Mallory-Weiss tear (5-10%)		**[[Mallory-Weiss tear]] (5-10%)
	** Erosive esophagitis (5-10%)		**[[Erosive esophagitis]] (5-10%)
	** Angioma (5-10%)		**[[Angioma]] (5-10%)
	** Arteriovenous malformation (<5%)		**[[Arteriovenous malformation]] (<5%)
	* Very rare		*Very rare
	** GIST		**[[GIST]]
	** Dieulafoy lesion		**[[Dieulafoy lesion]]
	** Cancer		**[[Cancer]]

	== Clinical Manifestations ==		==Clinical Manifestations==

	=== History ===		===History===

	* Hematemesis		*Hematemesis
	* Melena stools		*Melena stools
	* Nausea, abdominal pain		*Nausea, abdominal pain

	=== Signs & Symptoms ===		===Signs & Symptoms===

	* Hematemesis		*Hematemesis
	* Melena stools (50-100mL blood loss)		*Melena stools (50-100mL blood loss)
	* Hematochezia (500-1000mL blood loss)		*Hematochezia (500-1000mL blood loss)
	* Signs of hypovolemia or shock		*Signs of hypovolemia or shock
	* Signs of liver disease and portal hypertension, if variceal bleed		*Signs of liver disease and portal hypertension, if variceal bleed

	== Risk Stratification ==		==Risk Stratification==

	* Rockall score (requires endoscopy)		*Rockall score (requires endoscopy)
	* Blatchford score		*Blatchford score
	** >12 suggests need for endoscopy		**>12 suggests need for endoscopy
	* Forrest classification of ulcers on endoscopy		*Forrest classification of ulcers on endoscopy
	** 1a active spurting and 1b oozing have a 55% rebleed rate		**1a active spurting and 1b oozing have a 55% rebleed rate
	** 2a visible vessel and 2b adherent clot		**2a visible vessel and 2b adherent clot
	** 3 flat spot or clean-based ulcer		**3 flat spot or clean-based ulcer

	== Investigations ==		==Investigations==

	* Other		*Other
	** FOBT + with 10-20mL blood loss in UGIB (0.5mL in LGIB)		**FOBT + with 10-20mL blood loss in UGIB (0.5mL in LGIB)
	** Upper endoscopy within 24 hours		**Upper endoscopy within 24 hours

	== Management ==		==Management==

	* Fluid resuscitation		*Fluid resuscitation
	** pRBC to maintain ~~Hgb~~ ~~>~~70		**Transfuse pRBC to maintain hemoglobin over 70
	* Bleeding ulcer		*Bleeding ulcer
	** Pantoprazole ~~80mg~~ IV bolus then 8mg/h IV infusion x72h		**[[Pantoprazole]] 80 mg IV bolus then 8mg/h IV infusion x72h
	*** Reduces rebleeding of ulcers but not mortality		***Reduces rebleeding of ulcers but not mortality
	*** Alternate: Pantoprazole ~~40mg~~ IV bid x72h		***Alternate: [[Pantoprazole]] 40 mg IV bid x72h
	*** Step down to oral therapy bid x28d then to once daily		***Step down to oral therapy bid x28d then to once daily
	** OGD within 24 hours		**OGD within 24 hours
	* Variceal bleed		*Variceal bleed
	** Ceftriaxone 1g IV daily for 7 days		**[[Ceftriaxone]] 1 g IV daily for 7 days
	** Octreotide ~~50mcg~~ IV bolus then 50mcg/h IV infusion		**[[Octreotide]] 50 mcg IV bolus then 50mcg/h IV infusion
	** If bleeding continues, Blakemore tube (deflate within 12h for OGD)		**If bleeding continues, Blakemore tube (deflate within 12h for OGD)
	** OGD within 12h		**OGD within 12h
	* For both, endoscopy within 24h if Blatchford score >12 (urgent endoscopy not required)		*For both, endoscopy within 24h if Blatchford score >12 (urgent endoscopy not required)

	[[Category:Gastroenterology]]		[[Category:Gastroenterology]]

Aidan: Aidan moved page Upper gastrointestinal to Upper gastrointestinal bleed without leaving a redirect: typo

2020-08-02T14:39:17Z

Aidan moved page Upper gastrointestinal to Upper gastrointestinal bleed without leaving a redirect: typo

← Older revision		Revision as of 14:39, 2 August 2020
(No difference)

Aidan: Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

2020-08-02T12:16:22Z

Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

← Older revision		Revision as of 12:16, 2 August 2020
Line 16:		Line 16:
	** Cancer		** Cancer

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	=== History ===		=== History ===

Maintenance script: Imported from text file

2020-07-04T01:18:00Z

Imported from text file

New page

== Etiology ==

* Bleeding peptic ulcer
** Duodenal ulcer (20-30%)
** Gastric ulcer (10-20%)
* Gastric or duodenal erosion (20-30%)
* Bleeding esophageal varices (15-20%)
* Other
** Mallory-Weiss tear (5-10%)
** Erosive esophagitis (5-10%)
** Angioma (5-10%)
** Arteriovenous malformation (<5%)
* Very rare
** GIST
** Dieulafoy lesion
** Cancer

== Clinical Presentation ==

=== History ===

* Hematemesis
* Melena stools
* Nausea, abdominal pain

=== Signs & Symptoms ===

* Hematemesis
* Melena stools (50-100mL blood loss)
* Hematochezia (500-1000mL blood loss)
* Signs of hypovolemia or shock
* Signs of liver disease and portal hypertension, if variceal bleed

== Risk Stratification ==

* Rockall score (requires endoscopy)
* Blatchford score
** >12 suggests need for endoscopy
* Forrest classification of ulcers on endoscopy
** 1a active spurting and 1b oozing have a 55% rebleed rate
** 2a visible vessel and 2b adherent clot
** 3 flat spot or clean-based ulcer

== Investigations ==

* Other
** FOBT + with 10-20mL blood loss in UGIB (0.5mL in LGIB)
** Upper endoscopy within 24 hours

== Management ==

* Fluid resuscitation
** pRBC to maintain Hgb >70
* Bleeding ulcer
** Pantoprazole 80mg IV bolus then 8mg/h IV infusion x72h
*** Reduces rebleeding of ulcers but not mortality
*** Alternate: Pantoprazole 40mg IV bid x72h
*** Step down to oral therapy bid x28d then to once daily
** OGD within 24 hours
* Variceal bleed
** Ceftriaxone 1g IV daily for 7 days
** Octreotide 50mcg IV bolus then 50mcg/h IV infusion
** If bleeding continues, Blakemore tube (deflate within 12h for OGD)
** OGD within 12h
* For both, endoscopy within 24h if Blatchford score >12 (urgent endoscopy not required)

[[Category:Gastroenterology]]