Upper GI bleeding

Presentation: Melena, coffee ground in NG tube, BUN/Cre>30

Etiology: Peptic ulcer, Aorto-enteric fistula, Angiodysplasia, varices, malignancy, Mallory-Weiss tear, anticoagulant

Treatment

1.Fluid resuscitation

2.Unstable→ Hct<9 need transfusion, stable→ Hct<7 need transfusion, If INR>2 or platelet count<50000 need FFP

3.Acid suppression- Esomeprazole 40 mg IV twice daily after an initial bolus of 80 mg IV

4.Prokinetic- Erythromycin(3 mg/kg IV over 30 minutes, 30 to 90 minutes prior to endoscopy)(promote gastric emptying)

5.Vasoactive agent- Octreotide IV bolus of 50 mcg, followed by a continuous infusion at a rate of 50 mcg/hr

6.Anti-platelet and anti-coagulant- maybe need to hold

Diagnostic: Early endoscopy- within 24 hrs

Risk stratification

1.Rockall score- >2/11, age, the presence of shock, comorbidity, diagnosis, and recent hemorrhage

2.Glasgow Blatchford score- >0/23, blood urea nitrogen, hemoglobin, systolic blood pressure, pulse, and the presence of melena, syncope, hepatic disease, and/or cardiac fail

Published by Steve Johnson

I am a doctor who like to organise knowledges and share ideas with others. As a doctor, a lot of knowledges influx everyday and need some patient to organise and absorb. Here was my notes to share with you and hope to save your time to know it.

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