Upper gastrointestinal bleeding resident survival guide: Difference between revisions

Revision as of 19:08, 22 January 2014

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

Definition

This section provides a short and straight to the point definition of the disease or symptom in one sentence.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Management

Shown below is an algorithm summarizing the approach to [[disease name]].

Characterize the symptoms:

❑ Blood in vomiting
❑ Coffee ground emesis
❑ Black, tarry stools
❑ Frank blood in stools
❑ Maroon colored stool
❑ Abdominal pain
❑ Altered mental status
❑ Dizziness
❑ Syncope
❑ Palpitations

Elicit past medical history

❑ History of previous GI bleed
❑ Patient taking anticoagulants
❑ History of NSAIDs intake
❑ History of other comorbities

Physical examination

Abdominal examination

❑ Abdominal tenderness
❑ Involuntary guarding
❑ Bowel sounds

Hyperactive: Suggests UGIB

Hypoactive: Suggests mesenteric ischemia or ileus

❑ Signs of liver failure
❑ Rectal exam to assess stool color
❑ Guaiac test

❑ Signs of hypovolemia:

Severity of blood loss	Signs
Mild to moderate	Resting tachycardia
15% blood loss	Orthostatic hypotension
40% blood loss	Hypotension
Shock	Cold clammy extremities, Weak and thready pulse

Order tests

❑ Blood type and cross-match
❑ CBC
❑ Platelet count
❑ Prothrombin time and INR
❑ Liver enzymes
❑ BUN
❑ Creatinine
❑ Electrolytes
❑ EKG

Initial assessment

❑ Ensure normal breathing and clear airway
❑ Monitor vital signs
❑ Cardiac monitoring
❑ Assess mental status
❑ Monitor urine output

Initial resuscitative measures

❑ Nil per oral
❑ 2 large bore IV lines
❑

References

Template:WikiDoc Sources

@@ Line 24: / Line 24: @@
 {{familytree/start |summary=PE diagnosis Algorithm.}}
 {{familytree | | | | | | | | | | | | A01 |A01=<div style="float: left; text-align: left; height: 20em; width: 20em; padding:1em;">'''Characterize the symptoms:'''<br>
----- ❑ Blood in [[vomiting]]<br> ❑ Coffee ground emesis<br>❑ Black, tarry stools<br>❑ Frank blood in stools<br>❑ Maroon colored stool<br>❑ [[Abdominal pain]]<br>❑ [[Altered mental status]]<br>❑ [[Dizziness]]<br>❑ [[Syncope]] ❑ [[Palpitations]]<br></div>}}
+---- ❑ Blood in [[vomiting]]<br> ❑ Coffee ground emesis<br>❑ Black, tarry stools<br>❑ Frank blood in stools<br>❑ Maroon colored stool<br>❑ [[Abdominal pain]]<br>❑ [[Altered mental status]]<br>❑ [[Dizziness]]<br>❑ [[Syncope]]<br>❑ [[Palpitations]]<br></div>}}
 {{familytree | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | }}
 {{familytree | | | | | | | | | | | | E01 | | | | | | | | | | | | | | | | | | | |E01=<div style="float: left; text-align: left; height: 16em; width: 20em; padding:1em;">'''Elicit past medical history'''<br>
@@ Line 30: / Line 30: @@
 ❑ History of previous GI bleed<br>❑ Patient taking [[anticoagulants]]<br>❑ History of [[NSAIDs]] intake<br>❑ History of other comorbities</div>}}
 {{familytree | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | }}
-{{familytree | | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | | | | B01=<div style="float: left; text-align: left; height: 30em; width: 24em; padding:1em;">'''Physical examination'''<br>
+{{familytree | | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | | | | B01=<div style="float: left; text-align: left; height: 39em; width: 24em; padding:1em;">'''Physical examination'''<br>
 ----
-❑ [[Abdominal tenderness]]<br>❑ Involuntary [[guarding]]<br> ❑ [[Cirrhosis physical examination|Signs of liver failure]] <br>❑ [[Rectal exam]] to assess stool color<br>❑ [[Guaiac test]]<br>
+'''Abdominal examination'''<br>
+----
+❑ [[Abdominal tenderness]]<br>❑ Involuntary [[guarding]]<br>
+❑ Bowel sounds<br>
+: Hyperactive: Suggests UGIB<br>
+: Hypoactive: Suggests mesenteric ischemia or ileus<br>
+❑ [[Cirrhosis physical examination|Signs of liver failure]]<br>❑ [[Rectal exam]] to assess stool color<br>❑ [[Guaiac test]]<br>
 ----
 ❑ '''Signs of hypovolemia:'''<br>
@@ Line 43: / Line 49: @@
 <tr><td>[[Shock]]</td><td>Cold clammy extremities,<br> Weak and [[thready pulse]]</td></tr>
 </table>
 </div>}}
 {{familytree | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | }}