Upper gastrointestinal bleeding diagnostic criteria

Upper gastrointestinal bleeding Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Upper Gastrointestinal Bleeding from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Management Initial resuscitation Pharmacotherapy Risk stratification
Surgery Surgical Management Endoscopic Intervention
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Guidelines for Management
Case Studies
Case #1
Upper gastrointestinal bleeding diagnostic criteria On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Upper gastrointestinal bleeding diagnostic criteria All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Upper gastrointestinal bleeding diagnostic criteria
CDC on Upper gastrointestinal bleeding diagnostic criteria
Upper gastrointestinal bleeding diagnostic criteria in the news
Blogs on Upper gastrointestinal bleeding diagnostic criteria
Directions to Hospitals Treating Upper gastrointestinal bleeding
Risk calculators and risk factors for Upper gastrointestinal bleeding diagnostic criteria

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Diagnostic criteria

The diagnosis of upper GI bleeding is assumed when hematemesis is documented. In the absence of hematemesis, an upper source for GI bleeding is likely in the presence of at least two factors among: black stool, age < 50 years, and blood urea nitrogen/creatinine ratio 30 or more. In the absence of these findings, consider a nasogastric aspirate to determine the source of bleeding. If the aspirate is positive, an upper GI bleed is greater than 50%, but not high enough to be certain. If the aspirate is negative, the source of a GI bleed is likely lower. The accuracy of the aspirate is improved by using the Gastroccult test.

• 

  Gastric ulcer in antrum of stomach with overlying clot. Pathology was consistent with gastric lymphoma. Reproduced with permission of patient]]

• 

  Endoscopic image of small gastric ulcer with visible vessel]]

• 

  Same ulcer seen after endoscopic clipping]]

The nasogastric aspirate can help determine the location of bleeding and thus direct initial diagnostic and treatment plans. Witting found that nasogastric aspirate has sensitivity 42%, specificity 91%, negative predictive value 64%, positive predictive value 92% and overall accuracy of 66% in differentiating upper GI bleeding from bleeding distal to the ligament of Treitz. Thus, in this study a positive aspirate is more helpful than a negative aspirate. In a smaller study, Cuellar found a sensitivity of 79% and specificity of 55%, somewhat opposite results from Witting. Cuellar also studied the appearance of the aspirate and a summary of these results is available at the Evidence-Based On-Call database. Although the website lists these results as expired, they were available as of Oct, 16, 2006. These results are also available through the Wayback Archive and readers may consult the Archive if the original page is removed.

References

Template:WikiDoc Sources