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Flashcards in GI bleeding Deck (13):

Most common causes of upper GIB

1. Peptic ulcer disease;
2. Esophagogastric varices;
3. Esophagitis;
4. Mallory Weiss disease.


Upper GI bleeding
Glasgow-Blatchford score triage patient

1. Severity;
2. Needs for urgent intervention;


Upper GI bleeding

1. Pre-endoscopic care: resuscitation, HD monitoring, PPI therapy and attention to coagulopathy;
2. Early endoscopic evaluation and treatment;
3. Postendoscopic care and risk reducation.


Upper GI bleeding
Pre-endoscopic care

1. Fluid resuscitation goal: SBP>100 HR<100.
2. Blood transfusion: Hgb<7 and HD unstable;
3. PPI therapy;
4. Reverse coagulopathy: give FFP if INR>1.5 for patients who are on anticoagulation;
5. Octreotide and Antibiotics should be given if suspicious of variceal bleeding.


Upper GI bleeding
Endoscopic eval--Low risk ulcer

Feature: Clean-based or have nonprotuberant pigmented spot
Rx: Oral PPI, start feeding, planning discharge


Upper GI bleeding
Endoscopic eval--Intermediate ulcer

Feature: adherent clots
Rx: irrigation to dislogde the clot and then re-risk stratify.
If persistent clots, remain hospitalized and recieve IV PPI for 72 hours=high risk ulcers


Upper GI bleeding
Endoscopic eval--high risk ulcer

Feature: active arterial spurting or a non-bleeding visible vessles
Rx: hemoclips, thermal or injectino of sclerosants; IV PPI for 72 hours after endoscopic hemostasis--hospitalization for 3 days after endoscopy.


Upper GI bleeding
When to do a second-look endoscopy?

After 8-12 weeks of PPI therapy:
1. Sysmptoms are persistent despite therapy;
2. Ulcers have an endoscopic appearance that is concerning for underling malignancy;
3. Visualiztion of the stomach was incomplete;
4. Biopsies were not take at the time of the index upper endoscopy.


Upper GI bleeding
Postendoscopic care and Risk reduction
Who to test for H.Pylori

Upper GIB d/t peptic ulcer disease
Should start Rx if positive


Upper GI bleeding
When to hold antiplateltes agents:

ASA should be restarted 3-5 days for patients with established cardiovascular disease;
If on DAP, clopidogrel for be withheld for high-risk ulcers temporarily and restart ASAP.


Upper GI bleeding
Who takes long-term PPI?

1. Aspirin users who are H.Pylori negative;
2. NSAIDs, anticoagulants, glucocorticoids or other antiplatelet agents.


Upper GI bleeding
Who dose not long-term PPI

Aspirin users who are H.Pylori positive and finished treatment


Upper GI bleeding

1. Bridging treatment with LMW or heparin and observation; or 2. beginning oral anticoagluation 7 days after bleeding events.