Upper gastrointestinal bleeding diagnostic criteria: Difference between revisions

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==Overview==
==Diagnostic Criteria==
 
==Diagnostic criteria==
The diagnosis of upper GI bleeding is assumed when hematemesis is documented. In the absence of hematemesis, an upper source for GI bleeding is likely in the presence of at least two factors among: black stool, age < 50 years, and blood urea nitrogen/creatinine ratio 30 or more.  In the absence of these findings, consider a nasogastric aspirate to determine the source of bleeding. If the aspirate is positive, an upper GI bleed is greater than 50%, but not high enough to be certain. If the aspirate is negative, the source of a GI bleed is likely lower. The accuracy of the aspirate is improved by using the Gastroccult test.
The diagnosis of upper GI bleeding is assumed when hematemesis is documented. In the absence of hematemesis, an upper source for GI bleeding is likely in the presence of at least two factors among: black stool, age < 50 years, and blood urea nitrogen/creatinine ratio 30 or more.  In the absence of these findings, consider a nasogastric aspirate to determine the source of bleeding. If the aspirate is positive, an upper GI bleed is greater than 50%, but not high enough to be certain. If the aspirate is negative, the source of a GI bleed is likely lower. The accuracy of the aspirate is improved by using the Gastroccult test.


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The nasogastric aspirate can help determine the location of bleeding and thus direct initial diagnostic and treatment plans. Witting found that nasogastric aspirate has sensitivity 42%, specificity 91%, [[negative predictive value]] 64%, positive predictive value 92% and overall accuracy of 66% in differentiating upper GI bleeding from bleeding distal to the [[ligament of Treitz]]{{ref|3}}. Thus, in this study a positive aspirate is more helpful than a negative aspirate. In a smaller study, Cuellar found a sensitivity of 79% and specificity of 55%{{ref|4}}, somewhat opposite results from Witting. Cuellar also studied the appearance of the aspirate and a [http://www.eboncall.org/CATs/2190.html summary of these results] is available at the Evidence-Based On-Call database. Although the website lists these results as expired, they were available as of Oct, 16, 2006. These results are also available through the [http://web.archive.org/web/*/http://www.eboncall.org/CATs/2190.html Wayback Archive] and readers may consult the Archive if the original page is removed.
The nasogastric aspirate can help determine the location of bleeding and thus direct initial diagnostic and treatment plans. Witting found that nasogastric aspirate has sensitivity 42%, specificity 91%, [[negative predictive value]] 64%, positive predictive value 92% and overall accuracy of 66% in differentiating upper GI bleeding from bleeding distal to the [[ligament of Treitz]]{{ref|3}}. Thus, in this study a positive aspirate is more helpful than a negative aspirate. In a smaller study, Cuellar found a sensitivity of 79% and specificity of 55%{{ref|4}}, somewhat opposite results from Witting. Cuellar also studied the appearance of the aspirate and a [http://www.eboncall.org/CATs/2190.html summary of these results] is available at the Evidence-Based On-Call database. Although the website lists these results as expired, they were available as of Oct, 16, 2006. These results are also available through the [http://web.archive.org/web/*/http://www.eboncall.org/CATs/2190.html Wayback Archive] and readers may consult the Archive if the original page is removed.
==Overview==
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
There are no established criteria for the diagnosis of [disease name].
==Diagnostic Criteria==
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
**[Criterion 1]
**[Criterion 2]
**[Criterion 3]
**[Criterion 4]
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include
**[Criterion 1]
**[Criterion 2]
**[Criterion 3]
*The diagnosis of [disease name] is based on the [definition name] definition, which includes
**[Criterion 1]
**[Criterion 2]
**[Criterion 3]
OR
*There are no established criteria for the diagnosis of [disease name].


==References==
==References==
{{Reflist|2}}
{{reflist|2}}


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[[Category:Emergency medicine]]
[[Category:Needs patient information]]
[[Category:Needs overview]]
[[Category:Mature chapter]]
 


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Latest revision as of 17:22, 7 February 2018

Upper gastrointestinal bleeding Microchapters

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Overview

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Differentiating Upper Gastrointestinal Bleeding from other Diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Diagnostic Criteria

The diagnosis of upper GI bleeding is assumed when hematemesis is documented. In the absence of hematemesis, an upper source for GI bleeding is likely in the presence of at least two factors among: black stool, age < 50 years, and blood urea nitrogen/creatinine ratio 30 or more. In the absence of these findings, consider a nasogastric aspirate to determine the source of bleeding. If the aspirate is positive, an upper GI bleed is greater than 50%, but not high enough to be certain. If the aspirate is negative, the source of a GI bleed is likely lower. The accuracy of the aspirate is improved by using the Gastroccult test.

The nasogastric aspirate can help determine the location of bleeding and thus direct initial diagnostic and treatment plans. Witting found that nasogastric aspirate has sensitivity 42%, specificity 91%, negative predictive value 64%, positive predictive value 92% and overall accuracy of 66% in differentiating upper GI bleeding from bleeding distal to the ligament of Treitz[2]. Thus, in this study a positive aspirate is more helpful than a negative aspirate. In a smaller study, Cuellar found a sensitivity of 79% and specificity of 55%[3], somewhat opposite results from Witting. Cuellar also studied the appearance of the aspirate and a summary of these results is available at the Evidence-Based On-Call database. Although the website lists these results as expired, they were available as of Oct, 16, 2006. These results are also available through the Wayback Archive and readers may consult the Archive if the original page is removed.

Overview

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

Diagnostic Criteria

  • The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
    • [Criterion 1]
    • [Criterion 2]
    • [Criterion 3]
    • [Criterion 4]
  • The diagnosis of [disease name] is based on the [criteria name] criteria, which include
    • [Criterion 1]
    • [Criterion 2]
    • [Criterion 3]
  • The diagnosis of [disease name] is based on the [definition name] definition, which includes
    • [Criterion 1]
    • [Criterion 2]
    • [Criterion 3]

OR

  • There are no established criteria for the diagnosis of [disease name].

References


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