文档介绍：GI Hemorrhage
13 November 2017
David Hughes
Incidence
1-2% of all hospital admissions
mon diagnosis of new ICU admits
5-12% mortality
40% for recurrent bleeders
85% stop sponateously
Those with massive bleeding need urgent intervention
Only 5-10% need operative intervention after endoscopic interventions
Site
Upper
Esophageal
Stomach
Doudenum
Hepatic
Pancreatic
Lower
Small bowel
Colon
Anus
Etiology
85% are due to:
Peptic ulcer disease
Variceal hemorrhage
Colonic diverticulosis
Angiodysplasia
Chain of events
Recognize severity
Establish access for resusitation
Resusitate
Identify source
Intervention
Question #1
JB a 30 y/o with hematemesis presents with orthostatic hypotension, clammy hands, but without tachycardia. How much blood has he lost?
>40%
20-40%
10-20%
<10%
Question #1
JB a 30 y/o with hematemesis presents with orthostatic hypotension, clammy hands, but without tachycardia. How much blood has he lost?
b) 20-40%
Upper GI hemorrhage
How do you know its upper?
85% of all GI hemorrhage is upper
Hematemesis diagnostic
Don’t forget about nasal bleeding as possible source
Melena
Degradation of hemoglobin to hematin by acid
Bowel bacteria and digestive enzymes also contribute
Hematochezia
10% of patients with very rapid UGI source
Gastric varices