Upper gastrointestinal bleeding other diagnostic studies: Difference between revisions

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**Ethmoid sinus fracture with brain trauma  
**Ethmoid sinus fracture with brain trauma  
**Bronchial intubation.
**Bronchial intubation.
==Upper GI Endoscopy==
*Upper GI Endoscopy is considered investigation of choice for diagnosing and assessing the source of UGIB.<ref name="pmid12510452">{{cite journal |vauthors=Cappell MS, Friedel D |title=The role of esophagogastroduodenoscopy in the diagnosis and management of upper gastrointestinal disorders |journal=Med. Clin. North Am. |volume=86 |issue=6 |pages=1165–216 |year=2002 |pmid=12510452 |doi= |url=}}</ref><ref name="pmid23245297">{{cite journal |vauthors=Jaskolka JD, Binkhamis S, Prabhudesai V, Chawla TP |title=Acute gastrointestinal hemorrhage: radiologic diagnosis and management |journal=Can Assoc Radiol J |volume=64 |issue=2 |pages=90–100 |year=2013 |pmid=23245297 |doi=10.1016/j.carj.2012.08.001 |url=}}</ref><ref name="pmid12145792">{{cite journal |vauthors=Jensen DM, Kovacs TO, Jutabha R, Machicado GA, Gralnek IM, Savides TJ, Smith J, Jensen ME, Alofaituli G, Gornbein J |title=Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots |journal=Gastroenterology |volume=123 |issue=2 |pages=407–13 |year=2002 |pmid=12145792 |doi= |url=}}</ref>
*The American Society of Gastrointestinal Endoscopy guidelines recommend that upper gastrointestinal endoscopy be performed within 24 hours of presentation in all patients with UGIB
===Indications===
*Active UGIB
*Used for biopsy lesions for tissue diagnosis and to treat currently bleeding lesions.
===Complications===
Complications include
*Aspiration
*Esophageal perforation
*Cardiopulmonary complications secondary to anesthesia
*Increased bleeding while attempting therapeutic intervention
{{Family tree/start}}
{{Family tree | | | | | | A01 | | | |A01= If upper GI Endoscopy<br>undiagnostic<ref name="pmid12208839">{{cite journal |vauthors= |title=Non-variceal upper gastrointestinal haemorrhage: guidelines |journal=Gut |volume=51 Suppl 4 |issue= |pages=iv1–6 |year=2002 |pmid=12208839 |pmc=1867732 |doi= |url=}}</ref>}}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | B01 | | | |B01= Patient’s hemodynamic stability}}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | |,|-|-|^|-|-|.| | }}
{{Family tree | | | C01 | | | | C02 |C01= Stable<br>with low volume bleeding| C02= Unstable<br>with large volume bleeding}}
{{Family tree | | | |!| | | | | |!| | |}}
{{Family tree | | | D01 | | | | D02 | |D01=Repeat endoscopy|D02=Surgery<br>exploration and partial gastrectomy<ref name="pmid11997827">{{cite journal |vauthors=Zmora O, Dinnewitzer AJ, Pikarsky AJ, Efron JE, Weiss EG, Nogueras JJ, Wexner SD |title=Intraoperative endoscopy in laparoscopic colectomy |journal=Surg Endosc |volume=16 |issue=5 |pages=808–11 |year=2002 |pmid=11997827 |doi=10.1007/s00464-001-8226-3 |url=}}</ref> }}
{{Family tree/end}}


==References==
==References==

Revision as of 17:43, 6 November 2017

Upper gastrointestinal bleeding Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Other Diagnostic Studies

Nasogastric lavage

  • Nasogastric lavage is only indicated when the diagnosis of UGIB doubtful.[1][2]
  • It is rarely used now
  • Nasogastric lavage also helps in documenting active or recent UGIB and the need for urgent endoscopy.
  • Occasionally used to empty gastric contents in preparation for endoscopy.

Interpretation

  • Evidence of old (brown colored or 'coffee grounds') or fresh blood documents presence of UGIB.
  • Evidence of bilious material rules out bleeding distal to the pylorus.
  • Any other appearances of GI contents are non-diagnostic.
  • There is no evidence that performing a nasogastric lavage to clear clots or otherwise manage bleeding improves clinical outcome.
  • Determining whether blood is in gastric contents, either vomited or aspirated specimens, is surprisingly difficult.
  • Slide tests are based on orthotolidine (Hematest reagent tablets and Bili-Labstix) or guaiac (Hemoccult and Gastroccult).
  • Rosenthal found orthotolidine-based tests more sensitive than specific; the Hemoccult test's sensitivity reduced by the acidic environment; and the Gastroccult test be the most accurate[3]. Cuellar found the following results:
Determining whether blood is in the gastric aspirate[4]
Finding Sensitivity Specificity Positive predictive value
(prevalence of 39%)		 Negative predictive value
(prevalence of 39%)
Gastroccult 95% 82% 77% 96%
Physician assessment 79% 55% 53% 20%
  • Holman used simulated gastric specimens and found the Hemoccult test to have significant problems with non-specificy and false-positive results, whereas the Gastroccult test was very accurate[5].

Contraindications

  • Avoid gastric lavage in patients with suspected perforated abdominal viscus.

Complicatiions

Complications of the procedure include:

  • Bleeding from trauma during tube passage in patients with coagulopathy is a possible complication.
  • Other rare complications include
    • Pharyngeal and esophageal perforation
    • Cardiac arrest
    • Ethmoid sinus fracture with brain trauma
    • Bronchial intubation.

Upper GI Endoscopy

  • Upper GI Endoscopy is considered investigation of choice for diagnosing and assessing the source of UGIB.[3][4][5]
  • The American Society of Gastrointestinal Endoscopy guidelines recommend that upper gastrointestinal endoscopy be performed within 24 hours of presentation in all patients with UGIB

Indications

  • Active UGIB
  • Used for biopsy lesions for tissue diagnosis and to treat currently bleeding lesions.

Complications

Complications include

  • Aspiration
  • Esophageal perforation
  • Cardiopulmonary complications secondary to anesthesia
  • Increased bleeding while attempting therapeutic intervention
 
 
 
 
 
If upper GI Endoscopy
undiagnostic[6]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Patient’s hemodynamic stability
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stable
with low volume bleeding
 
 
 
Unstable
with large volume bleeding
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Repeat endoscopy
 
 
 
Surgery
exploration and partial gastrectomy[7]
 

References

  1. ↑ Pallin DJ, Saltzman JR (2011). "Is nasogastric tube lavage in patients with acute upper GI bleeding indicated or antiquated?". Gastrointest. Endosc. 74 (5): 981–4. doi:10.1016/j.gie.2011.07.007. PMID 22032314.
  2. ↑ Marshall JB (1982). "Management of acute upper gastrointestinal bleeding". Postgrad Med. 71 (5): 149–54, 157–8. PMID 6978482.
  3. ↑ Cappell MS, Friedel D (2002). "The role of esophagogastroduodenoscopy in the diagnosis and management of upper gastrointestinal disorders". Med. Clin. North Am. 86 (6): 1165–216. PMID 12510452.
  4. ↑ Jaskolka JD, Binkhamis S, Prabhudesai V, Chawla TP (2013). "Acute gastrointestinal hemorrhage: radiologic diagnosis and management". Can Assoc Radiol J. 64 (2): 90–100. doi:10.1016/j.carj.2012.08.001. PMID 23245297.
  5. ↑ Jensen DM, Kovacs TO, Jutabha R, Machicado GA, Gralnek IM, Savides TJ, Smith J, Jensen ME, Alofaituli G, Gornbein J (2002). "Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots". Gastroenterology. 123 (2): 407–13. PMID 12145792.
  6. ↑ "Non-variceal upper gastrointestinal haemorrhage: guidelines". Gut. 51 Suppl 4: iv1–6. 2002. PMC 1867732. PMID 12208839.
  7. ↑ Zmora O, Dinnewitzer AJ, Pikarsky AJ, Efron JE, Weiss EG, Nogueras JJ, Wexner SD (2002). "Intraoperative endoscopy in laparoscopic colectomy". Surg Endosc. 16 (5): 808–11. doi:10.1007/s00464-001-8226-3. PMID 11997827.



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