UGIB Flashcards
Management unstable GIB
- 2 large bore IV
- Cardiac monitoring
- O2 PRN
- Severe active bleeding - transfuse
- Reverse coagulopathy
- PPI
- Octreotide for variceal
- consider erythromycin 250mg IV push for better endoscopy views
How much pRBC transfused initially for active, severe bleeding
4u
Investigations for UGIB
CBC, Chemistry, INR, Group and Screen
EKG, troponin if they have chest pain
Management of coagulopathy
Hold anticoagulant
Vitamin K 10mg (can give slowly IV)
FFP/PCC
Octreotide mechanism
Somatostatin analog
Octreotide evidence
does not decrease mortality in UGIB from varices, but with endoscopy increases initial hemostasis and decreases rebleeding
PPI evidence
does not improve mortality but can decrease risk off rebleeding
When to transfuse in UGIB
<70
Predictive features of UGIB
Melena
NG lavage (with no history of hematemesis)
BUN:Cr >30
Hematocrit <20
Anticoagulants
Factors that decrease likelihood of UGI source of bleeding
Blood clots in feces
History of LGIB
Features of severe UGIB that require intervention
History of malignancy, cirrhosis, syncope, analgesia use
HR >100
NG lavage with BRB
HGB <80 BUN >90 WBC >12
Treatment of ruptured esophageal varices
- octreotide bolus and infusion
- balloon tamponade device
- endoscopic band ligation
- if cirrhosis - ppx abx
Benefit of ppx abx in cirrhotics with UGIB
- decrease ACM
- decrease rebleeding
- decrease death from bacterial infection
- decrease LOS
Advance treatment of esophageal varices
- angiography with gastric vein embolization
- transjugular intrahepatic portosystemic shunt to prevent rebleeding in refractory bleeding
- surgery (rare)
Most common cause of source for UGIB in all patients
peptic ulcer
