Upper gastrointestinal bleeding other diagnostic studies: Difference between revisions
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*Any other appearances of GI contents are non-diagnostic. | *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. | *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{{ref|5}}. Cuellar found the following results: | |||
{| class="wikitable" style="text-align:center" | |||
|+ Determining whether blood is in the gastric aspirate{{ref|4}} | |||
! Finding !! Sensitivity !! Specificity !! Positive predictive value<br>(prevalence of 39%)!! Negative predictive value<br>(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{{ref|6}}. | |||
====Contraindications==== | ====Contraindications==== | ||
Revision as of 17:41, 6 November 2017
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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.
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.
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:
| 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.
References
- ↑ 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.
- ↑ Marshall JB (1982). "Management of acute upper gastrointestinal bleeding". Postgrad Med. 71 (5): 149–54, 157–8. PMID 6978482.