Bleeding from the upper gi tract is four times as common as from the lower gi tract and is a major cause of morbidity, particularly among patients with comorbid illnesses which is the case in up to 50% of patients. Upper gi endoscopy, which should be performed if there is a history of upper gi bleeding or a positive fecal occult blood test. Consensus recommendations for managing patients with. This will allow localisation of the bleeding point.
The first category is consequent to portal hypertension and formation. Approach to upper gastrointestinal bleeding youtube. Gi bleeds are classified into upper or lower in regards to the location of the bleeding. Gastrointestinal gi hemorrhage is an important cause of blood loss that is more commonly encountered in dogs than cats. Upper gastrointestinal bleeding ugib refers to gi blood loss whose origin is proximal to the ligament of treitz at the duodenojejunal junction. Management of acute upper gastrointestinal bleeding. The management of patients with acute nonvariceal upper gastrointestinal bleeding has evolved. There have been many advances in the management of this condition since the first edition of gastrointestinal bleeding. In the event of an acute bleed, the patient must be resuscitated in line with first principles. Gastrointestinal gi bleeding may occur in any part of your digestive tract.
Sanders6, matthew kurien6, gianluca rotondano7, tomas hucl8, mario dinisribeiro9, riccardo marmo10, istvan racz11, alberto arezzo12. A well structures emergency treatment and timely diagnostic approach based on suspected cause of bleeding can significantly reduce mortality rates in these patients. It may identify sources of an upper gi bleed peptic ulcer disease, gastritis, esophageal varices, hiatus hernia, meckel diverticulum, or increased gastric ph in achlorhydria. Neonatal gastrointestinal bleeding blood in the stool in the neonatal period is a common problem with a variety of causes that range from benign to life threatening. To understand how to assess a patient who has upper gi and midgi bleeding to tell the current medical treatment for upper gi and midgi bleeding.
Upper gastrointestinal hemorrhage, gastrorrhagia, upper gi bleed, ugi bleed. Lower gastrointestinal bleeding lgib is a common problem that can be treated via a number of endoscopic, radiological and surgical approaches. Acute overt lower gastrointestinal bleeding lgib accounts for. Approach to upper gastrointestinal bleeding upper gi bleeding is the most common complication of peptic ulceration and portal hypertension. This article provides an overview on the common causes of acute. Introduction upper gastrointestinal bleeding ugib is a poten.
This clinical practice guideline cpg on ugib was developed under the direction of drs. Upper gastrointestinal bleeding is a common medical. Although traditionally managed by the colorectal surgeons, surgery should be considered a last resort given the variety of endoscopic and radiological approaches available. Overt gastrointestinal gi bleeding is a common reason for hospitalization. Also avoid foods that cause heartburn, nausea, or diarrhea. Clinical approach to manage gastrointestinal bleeding with.
Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage. Design plans for the prevention of upper gi bleed ing caused by commonly associated risk factors. Despite changes in management, mortality has not significantly improved over the past 50 years. Upper gastrointestinal bleeding causes significant morbidity and mortality in the united states, and. Evaluation of upper gi bleed approach bmj best practice. Approach to acute upper gastrointestinal bleeding in adults. Your bleeding may begin suddenly, or start slowly and last for a longer period of time. Upper gi bleeding is the most common complication of peptic ulceration and portal hypertension. Lower gastrointestinal bleeding lgib may occur in the colon. See approach to the patient with upper gastrointestinal bleeding and see approach to minimal bright red bleeding per rectum and see evaluation of occult and obscure gastrointestinal bleeding. Diagnosis and management of upper gastrointestinal bleeding. Marshall, md, msc, for the nonvariceal upper gi bleeding consensus conference group background. While gastro esophageal variceal bleed is responsible for 530% cases and esophagitis causes upto 210% of upper gi bleed.
Endoscopy plays a major role both in diagnosis and management of bleeding throughout the entire gastrointestinal tract. There are various causes of bleeding in different regions. Low risk upper gi bleeding pathway royal college of. Up to 60% of patients with a history of an upper gi bleed are bleeding. Almost all people who develop acute upper gastrointestinal bleeding are treated in hospital and the guideline therefore focuses on hospital care. A logical, reasoned approach is essential to the successful management of gastrointestinal hemorrhage. The differential diagnosis of ugib in children is determined by age and severity of bleed. Apr 22, 2016 this feature is not available right now. The desirable effects of an intervention clearly outweigh the undesirable effects.
Nasogastric or orogastric lavage is not required in patients with upper gi bleeding for diagnosis, prognosis, visualization, or therapeu tic effect. Gi bleeding itself is not a disease, but a symptom of any number of conditions. Management of upper gastrointestinal bleeding annals of. Upper gi bleed bottom line ugib requires rapid assessment of the patient and resuscitation as needed. Sep 14, 2012 approach to upper gi bleeding for medical students. Approach to the patient with lower gastrointestinal bleeding. Mar 11, 2016 acute upper gastrointestinal bleeding ugib is a gastroenterological emergency. Upper gi bleeding ugib is defined as bleeding derived from a source proximal to the ligament of treitz. Compared with acute upper gi bleeding ugib, patients with lgib tend to present with a higher hemoglobin level and are less likely to develop hypotensive shock or require blood transfusions.
A uk audit in 2007 found an overall mortality of 10%. Reference international consensus upper gastrointestinal bleeding conference group recommendations on management of patients with nonvariceal upper gastrointestinal bleeding mnh 20083829 p mdc 20083829 p ann intern med 2010 jan 19. Management and prevention of upper gi bleeding accp. Causes the following causes of git bleeding have been decribed. A stepbystep approach to managing gastrointestinal bleeding. Using a stepwise approach to diagnose and treat gastrointestinal bleeding can improve patient outcomes. Approach to a child with upper gastrointestinal bleeding. Stulak jm, lee d, haft jw, et al gastrointestinal bleeding and subsequent risk of thromboembolic events during support with a left ventricular assist device. Therefore, the primary focus in a child with ugib is resuscitation and stabilization followed by a diagnostic evaluation. Upper gastrointestinal bleeding, lower gastrointestinal.
Gastrointestinal bleeding can be a a signal of a serious disease. Bleeding that requires more than three units of blood in 24 hours usually demands operative measures. Upper gastrointestinal bleeding ugib is defined as bleeding derived from a source proximal to the ligament of treitz. Watch in hd 1080p and fullscreen for best resolution. It is the dedication of healthcare workers that will lead us through this crisis. Aug 12, 2019 acute gastrointestinal bleeding is a potentially lifethreatening abdominal emergency that remains a common cause of hospitalization. Assessing upper gastrointestinal bleeding in adults. Upper gi barium studies are contraindicated in the setting of acute upper gi bleeding because they will interfere with subsequent endoscopy, angiography, or surgery.
Upper gastrointestinal ugi bleeding arising proximal to the ligament of treitz in the distal duodenum commonly presents with hematemesis vomiting of red blood or coffee groundlike material andor melena black, tarry stools. Design plans for the prevention of upper gi bleeding caused by commonly associated risk factors. Mar 01, 2012 upper gastrointestinal bleeding causes significant morbidity and mortality in the united states, and has been associated with increasing nonsteroidal antiinflammatory drug use and the high. Approach to upper gastrointestinal bleeding approach2im. Lower gastrointestinal tract bleeding or lgi or lower gi bleeding is one of the most common serious presenting complaint by patients in emergency or opd, to differentiate and treat according through the protocol is the art a doctor should learn. Gastrointestinal bleeding may be a lifethreatening condition. Upper gi bleeding is nearly twice as common in males as in females, and its incidence increases with age, a pattern that has been attributed to increased incidence of predisposing comorbid conditions. American college of gastroenterology guideline on the management of helicobacter pylori eradication. Rarely, massive upper gi bleeding can present with hematochezia.
Gastrointestinal bleeding following lvad placement from top to bottom. Gi bleeding gi diseases, complications and management. Devise a plan to effectively manage acute gi bleeding and optimize treatment responses in the individual patient. Sep 21, 2016 for the last week he had been having upper respiratory tract symptoms and had daily doses of ibuprofen for his low grade fever. Although most patients with acute lgib stop bleeding spontaneously and have favorable outcomes, morbidity and mortality are increased in. Elderly patients and people with chronic medical diseases withstand acute upper gastrointestinal. Diagnosis and management of upper gastrointestinal bleeding in. Upper gastrointestinal bleeds ugi bleeds aetiology of upper gi ugi bleeds peptic ulcer disease oesophageal, gastric or duodenal ulcers prevalence 4% of the population due to h. Current treatment of lower gastrointestinal hemorrhage. Upper gastrointestinal bleeding causes significant morbidity and mortality in the united states, and has been associated with increasing nonsteroidal antiinflammatory drug use and the high. The approaches to patients with upper gi bleeding, minimal rectal bleeding, and occult gi bleeding are presented separately.
This new edition, thoroughly revised and restructured, includes the latest updates on all areas of the field of gi bleeding, systematically covering all the areas of the gi tract, from upper gi to lower gi, through to small bowel bleeding. Upper gastrointestinal bleeding objectives peptic ulcer disease. Uw department of family medicine resident, allison hotujec, md, discusses the best approaches to acute gi bleed. Figure 1 provides an algorithmic approach to the management of acute upper gastrointestinal bleeding. Approach to the patient with gastrointestinal bleeding.
Find out about gi tract symptoms, tests, and related conditions. Upper gastrointestinal bleeding occurs above the ligament of treitz as a result of duodenal or gastric ulcers, gastric or esophageal varices caused by cirrhosis of the liver, or malloryweiss syndrome. The causes and risk factors for gastrointestinal gi bleeding are classified into upper or lower, depending on their. Although certain key features on history and physical exam can help to differentiate potential causes, egd is often required for definitive diagnosis and management. Past medical history patients should be asked about prior episodes of upper gi bleeding, since up to 60 percent of patients with a history of an upper gi bleed are bleeding from the same lesion.
Nasogastric lavage is a procedure that can be used to determine whether the bleeding is in the upper or lower digestive tract. Upper gastrointestinal bleeding ugib bleeding rockall score. The most important causes are peptic ulcer and oesophagogastric varices. European society of gastrointestinal endoscopy esge guideline authors ian m. Conditional, lowquality evidence gi ulcer recommendation strength of evidence classification. Approach to lower gi bleeding less common than ugi bleeding usually less hemodynamicaly significant most common cause of severe bleeding. The gi tract includes your esophagus, stomach, small intestine, large intestine, rectum, and anus.
Approach to management of upper gastrointestinal gi bleeding. Murphy is a 45 year old advertising executive who presents to the emergency room complaining of the passage of black stools x 3 days and an associated lightheadedness. Evaluation of upper gi bleed differential diagnosis of. Gi bleeding general presentation gastrointestinal gi bleeding can be an emergency in children when the blood loss is large, but always requires further investigation. Low risk upper gi bleeding pathway for ed by dr nina lewis edgastro nov 2014. Sources of gi bleeding upper gitract proximal to the ligament oftreitz 80% of acute gi bleeds lower gitract distal to the ligament oftreitz 20% of acute gi bleeds 3.
C 4, 14 early upper endoscopy within 24 hours of presentation is recommended in most patients with upper gastrointestinal bleeding. Acute ugib can manifest in a variety of ways, with or without hemodynamic compromise, including hematemesis, coffeeground emesis, the return of bright. Approach to upper gastrointestinal bleeding in children. Jonathan lidbury, bvms, mrcvs, phd, dacvim, decvim. To discuss the acute management of upper gi bleeding peptic ulcers with a focus on antisecretory therapy. Thereafter it is important to determine if portal hypertension and varices are likely from the history and physical examination. Review date nov 2016 low risk upper gi bleeding pathway background low risk upper gi bleeding may be safely managed without an emergency admission to nuh following presentation to the ed. A practical approach to diagnosis and management provides a ready reference that will help physicians understand and work through diagnostic and therapeutic dilemmas and will be of great value to full range of practitioners that manage patients with bleeding including surgeons, gastroenterologists and radiologists as. A blood test can help determine the extent of the bleeding and whether the patient is anemic.
Causes of bleeding in the upper and lower gastrointestinal tract. The diagnostic approach includes history, examination, laboratory evaluation, endo. If there has been a hematemesis the patient must have gastroduodenoscopy as soon as it can be arranged. After initial resuscitation, care should be taken to localize the site of bleeding. Approach to upper gastrointestinal bleeding thomson. Key clinical pointsacute lower gastrointestinal bleeding colonoscopy should be the initial procedure for most patients presenting with acute lower gastrointestinal bleeding.
Clinical approach to the patient with acute gastrointestinal bleeding. Gastrointestinal bleeding discharge care what you need to. Gastrointestinal bleeding discharge care what you need. Gastrointestinal bleeding knowledge for medical students. Differential diagnoses it would be appropriate to consider the differential diagnoses of gi bleeding, depending on the pre. The glasgowblatchford bleeding score gbs stratifies upper gi bleeding patients who are lowrisk and candidates for outpatient management. Bleeding that lasts for a longer period of time is called chronic gi bleeding. Barkun and marc bardou, in accordance with the policies and procedures of the cag and under the direction of cag clinical affairs.
Jul 27, 20 approach to gastrointestinal bleeding samir haffar m. Madanick, md assistant professor of medicine a free powerpoint ppt presentation displayed as a flash slide show on id. Key elements of an approach to gastrointestinal haemorrhage. This will cause intense vasoconstriction and narrowing of the vessel lumen by a sheer volume effect. An approach to acute lower gastrointestinal bleeding. To discuss secondary prevention strategies following acute stabilization of acute gi bleeding peptic ulcers. The digestive or gastrointestinal tract goes from the mouth to the anus. Gastrointestinal bleeding is a common medical problem that is managed by clinicians in a variety of medical specialties. Endoscopic image of a posterior wall duodenal ulcer with a clean base, which is a common cause of upper gastrointestinal hemorrhage.
Upper gastrointestinal bleeding ugib is a potentially life threatening medical emergency requiring an appropriate diagnostic and therapeutic approach. This chapter examines the approach to patients hospitalized for severe gi bleeding and describes various causes for. Pdf management of acute upper gastrointestinal bleeding. Pdf gastrointestinal bleeding gib is a very common condition at all ages, with. This article describes the approach used by the staff of the ochsner clinic foundations department of colon and rectal surgery to evaluate and manage lower gastrointestinal hemorrhage, along with the evidence and experience that guided its development. Evaluation and management of gastrointestinal bleeding. This article covers the acute management of patients with overt upper gastrointestinal bleeding, abstract. The role of endoscopy in the patient with lower gi bleeding. To use clinical clues to differentiate between upper and.
Aug 12, 2019 acute gastrointestinal gi bleeding is a potentially lifethreatening abdominal emergency that remains a common cause of hospitalization. Aug 06, 2019 different parts of the digestive tract are affected by specific conditions. Management of upper gi bleeding, in particular, underwent a major transition with the advent of proton pump inhibitor therapy. Upper gastrointestinal bleeding causes significant morbidity and mortality in the united states, and has been asso ciated with increasing nonsteroidal antiinflammatory drug use and the high. Upper gib can be divided into variceal and non variceal bleeding. Management of gastrointestinal bleeding clinical gate. Patients with acute upper gastrointestinal gi bleeding commonly. Oct 16, 2017 optimizing endoscopicvisualization visualization of blood within the gi tract is a challenge in managing patients with gi bleed. This includes your esophagus, stomach, intestines, rectum, or anus. Stool tests can also show bleeding that is not visible to the patient. The cpg was developed after a thorough consideration of the medical.
Associated professor of gastroenterology slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. There is also interest in using wireless capsule endoscopy for patients who have presented to the emergency department with suspected upper gi bleeding. The upper gi tract consists of the oral cavity, esophagus, stomach, and the first part of the small intestine the duodenum. Main etiologies of acute upper gastrointestinal bleeding. Eat small meals more often while your digestive system heals. Gastrointestinal bleeding is categorized as either upper or lower bleeding, with the ligament of treitz serving as an anatomical landmark to differentiate between the two. Gastrointestinal gi bleeding is when bleeding occurs in any part of the gastrointestinal tract. Upper gastrointestinal bleeding is defined as bleed ing from. We will discuss the topic in detail along with the protocol or approach followed for same.
Upper gib can be divided into variceal and nonvariceal bleeding. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. For nonvariceal haemorrhage the tried and tested modality is injection with 110 000 solution of adrenaline. Learn about upper gastrointestinal bleeding ugib bleeding and rockall score. Blood transfusions generally should be administered to patients with upper gastrointestinal bleeding who have a hemoglobin level of 7 g per dl 70 g per l or less. If variceal bleeding is suspected patients are started on octreotide. Bleeding in the upper gi tract can happen anywhere from the esophagus to the first part of the small intestine. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding alan barkun, md, msc. Approach to gastrointestinal bleeding free download as powerpoint presentation. Patients present with hematemesis bloody or coffee ground emesis or melena, although hematochezia can occur in the context of a major bleed and is typically associated with hemodynamic insta bility.
Upper gastrointestinal bleeding is an uncommon but potentially serious, lifethreatening condition in children. A special diet can help treat gi conditions and prevent problems such as gi bleeding. Epidemiology 15,000 admissions annually in canada 55% caused by peptic ulcer disease helicobacter pylori. Approach to upper gastrointestinal bleeding or what to do when the nurse starts panicking ryan d. Upper gi bleeds manifest as melena, hemetemesis and occasionally hematochezia. Acute upper gi bleeding requires an accurate assessment at presentation with a focus on resuscitation and appropriate monitoring.
Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. Upper gi bleeding has an annual incidence of approximately 67 to 150 per 100,000, with estimated mortality rates between 6% and 15%. Diagnosis and management of upper gastrointestinal. Upper gastrointestinal bleeding ugib is a common medical emergency, with a reported. Acute upper gastrointestinal bleeding is a common medical emergency that has a 10% hospital mortality rate. This entity has an annual incidence of 48 to 160 cases per 100,000 adults, with a mortality. General presentation gastrointestinal gi bleeding can be an emergency in children when the blood loss is large, but always requires further investigation. Pdf gastrointestinal bleeding is a common problem encountered in the.
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