gitbleeding_upper
upper GIT bleeding
Introduction
Aetiology
Mx in ED
the extremely low risk patient
subacute or chronic iron deficiency anaemia without active bleeding
treat the iron deficiency anaemia on its merits (may need blood transfusion, iron infusion or supplemental oral iron)
if there is no active bleeding, refer back to GP to arrange gastroscopy and colonoscopy
the low risk acute bleed
small amount of coffee ground vomit with no high risk features such as either of:
tachycardia (eg. > 100 for adults)
hypotension (eg., systolic < 110mmHg for adults)
syncope
PH liver disease
PH cardiac failure
melaena - a PR exam is usually required to exclude this
FBE, U&E, Xmatch, LFTs, lipase, coagulation profile
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assess for possible referral to GP to arrange gastroscopy as an outpatient (see risk assessment below)
upper GIT bleed in the patient with cirrhosis
most of the rest
assuming patient does not have an Advanced Care Directive that indicates otherwise, have a low threshold for aggressive early resuscitative Rx as significant bleeds can be occult initially
FBE, U&E, LFTs, lipase, CRP, Xmatch, coagulation profile
if significant haemorrhage or patient is in shock:
large bore IV access (at least 18G in a large vein) x 2
resuscitate with fluid replacement (preferably with blood)
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may need FFP if INR > 1.5
may need platelets if platelet count < 50 x 109/L
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eg. iv bolus
omeprazole 80mg in 100mL NSaline followed by infusion at 8mg/hr for 72hrs
early referral to gastroenterology as may need endoscopy within 24hrs
early endoscopy aids diagnosis, finds the bleeding source in 90%, may allow Rx such as adrenaline injection, sclerotherapy, etc, and decreases hospital length of stay.
may need surgery or angiography if endoscopy fails
Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage
Low Risk Criteria of Glasgow-Blatchford bleeding score
urea <6.5 mmol/L
Haemoglobin >130 g/L (men) or >120 g/L (women)
systolic BP > 110 mmHg
pulse <100 bpm
absence of melaena, syncope, cardiac failure or liver disease
gitbleeding_upper.txt · Last modified: 2020/06/22 22:11 by gary1