GI bleeding guidelines Flashcards
GI bleeding
What is the most common cause of GI Bleeding?
Non-portal hypertension bleed (80 to 90 %)
T\F
Hematochezia only appear with LGIB
False. 10 % Of hematochezia are due to UGIB
What is the role of FOBT in GI bleeding diagnosis?
No role.
Only used on colon cancer screening.
How to risk stratify a patient with GU bleeding?
Glasgow-blatchford score
How do you interpret Glasgow-blatchford score?
0(Low risk): Outpatient management
1: admission
more than 6 (IM to high risk): > 50 % need intervention
More than 12: will benefit from EGD
What other GI bleeding score you know?
1) Rockall score
2) AIM-65 (Used to identify high risk for death patients)
GI bleeding management
What is the goal of Hemoglobin in patient with GI Bleeding?
General population: 7 to 8
CAD patients: 9 to 10
Can you do endoscopy with high INR?
INR <2.5 Is reasonable to perform endoscopy in bleeding patients.
Type of fluid in GI bleeding?
No difference between RL or NS
Which one is preferred?
- Restrictive or liberal IV fluid?
Restrictive fluid resuscitation was non-inferior from liberal IV fluid
Liberal or restrictive blood transfusion in GI Bleeding?
restrictive.
associated with lower risk of mortality and further bleeding
Any pre-endoscopic pharmacological treatment?
1) Erythromycin 250 mg IV over 20 to 30 minutes.
- Reduce the need of repeated endoscopy
- Enhance visualization.
2) PPI:
- Allows for clot stabilization.
What is the role of emergency endoscopy?
Emergency = within 12 hours
associated with poor outcomes.
What is forest classification?
PPI dose post-endoscopy?
IV PPI infusion should be used only in high risk stigmata
For flat spot or clean base ulcer: Oral PPI
NGT role in GI Bleeding
Has no role
