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| {{Hematemesis}} | | {{Hematemesis}} |
| {{CMG}} {{JFS}}
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| ==Overview==
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| ==Primary Prevention==
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| Treatment of underlying disease is the best way to prevent hematemsis.
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| ===Prophylaxis Against Bleed From Variceal Hemorrhage and Ulceration ===
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| *Primary prophylaxis against variceal hemorrhage is indicated because of high rate of bleeding from esophageal varices and the high mortality associated with bleeding. Prophylactic [[propranolol]] or [[nadolol]] therapy is the only cost-effective therapy in this setting.
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| *Prophylaxis against [[stress]] ulceration maybe also indicated for ICU patients with any of the following characteristics:
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| #[[Coagulopathy]]
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| #Mechanical ventilation for more than 2 days
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| #History of GI ulceration or bleeding with the past year
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| #Two or more of the following risk factors — [[sepsis]], ICU admission lasting >1 week, occult GI bleeding lasting ≥6 days, and [[glucocorticoid]] therapy.
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| *Effective identification and antibiotic treatment of H.Pylori infections is also crutial in preventing complications including upper GI bleeding.
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| *In regards to the prevention of NSAID-related peptic ulcer disease and complicating upper GI bleed: patients are at the highest risk for NSAID-induced GI toxicity when they have any of these risk factors:
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| #A history of an ulcer or GI hemorrhage
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| #Age >60
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| #High dosage of a NSAID
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| #Concurrent use of glucocorticoids
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| #Concurrent use of anticoagulants
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| In these patients, the use of COX-2 selective inhibitor or a nonselective NSAID in combination with a PPI or misoprostol is indicated.
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| In addition, patients with a history of uncomplicated or complicated peptic ulcers should be tested for H. pylori prior to beginning a NSAID or low dose aspirin. If present, H. pylori should be treated with appropriate therapy, even if it is believed that the prior ulcer was due to NSAIDs.
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
| [[Category:Needs content]] | | [[Category:Needs content]] |
| | [[Category:Gastroenterology]] |
| | [[Category:Emergency medicine]] |
| | [[Category:Intensive care medicine]] |
| | [[Category:Vomiting]] |
| | [[Category:Signs and symptoms]] |
| | [[Category:primary care]] |
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