Upper gastrointestinal bleeding laboratory findings: Difference between revisions
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{{Upper gastrointestinal bleeding}} | {{Upper gastrointestinal bleeding}} | ||
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==Laboratory Findings== | ==Laboratory Findings== | ||
Laboratory findings include [[anemia]], [[coagulopathy]], and an elevated [[BUN-to-creatinine ratio]]. | * Laboratory findings include [[anemia]], [[coagulopathy]], and an elevated [[BUN-to-creatinine ratio]]. | ||
* 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}}. Holman found that by 120 seconds after the developer was applied, the Hemoccult test was positive on ''all'' control samples. | |||
==References== | ==References== | ||
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Revision as of 17:59, 7 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Laboratory Findings
- Laboratory findings include anemia, coagulopathy, and an elevated BUN-to-creatinine ratio.
- 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[2]. 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[4]. Holman found that by 120 seconds after the developer was applied, the Hemoccult test was positive on all control samples.