Table Of Contents
Gastrointestinal Bleeding
| Primary Symptoms | Differentials |
|---|---|
| Hematemesis or Melena | Ruptured Oesophageal varices, Dieulafoys’s lesion, PUD, Meckel’s diverticulum, Gastric or esophageal cancer, Mallory-Weiss tear, Celiac disease, Esophagitis, Gastritis, Aortoenteric fistula |
| Hematochezia | Diverticulosis, Angiodysplasia, Intussusception, Colon cancer, Hemorrhoids, IBD, Ischemic colitis, Infectious diarrhoea |
A patients who present with at least one Gastrointestinal “ALARM” symptom needs an EGD
- Gastrointestinal “ALARM Symptoms”
- Anemia, Age > 45y
- Loss of weight (unintended)
- Anorexia or Early satiety
- Recently progressive symptoms
- Melena/ Hematemesis/Hematochezia/ Heme + stool
- Symptoms present for > 6 month, Odynophagia, Dysphagia
- Initial management of upper gastrointestinal bleeding
- Resuscitation
- Secure airway
- Two peripheral Large bore IV access points
- Bolus Fluids if significant recent loss (vomiting or hematemesis)
- Nasogastric tube with lavage: diagnostic and prognostic for UGIB
- Upper GI Endoscopy (EGD)
- Pharmacotherapy
- Intravenous PPIs e.g. esomeprazole**:** Protect stomach and duodenum
- Intravenous octreotide: if the cause is variceal bleed
- Intravenous ceftriaxone or fluoroquinolole: for prophylaxis against SBP in patients with ascites
- Laboratory investigations
- CBC
- LFTs: to rule out hepatic causes
- GXM with blood products on hand
- PT/PTT
- Resuscitation
- Initial management of lower gastrointestinal bleeding (LGIB)
- Resuscitation
- Secure airway
- Two peripheral large-bore IV access points
- Bolus fluids if significant recent loss (vomiting, hematochezia, diarrhea)
- NG tube with lavage (to rule out UGIB; UGI endoscopy eventually to definitively rule out UGIB)
- Colonoscopy
- Laboratory tests
- CBC
- PT/PTT
- GXM blood products on hand
- Resuscitation
