For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 7080 gl are recommended. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. Guideline recommendations from the international consensus group free. Transfusion strategies for acute upper gastrointestinal bleeding. Blood may be observed in vomit or in altered form as black stool. Elderly patients and people with chronic medical diseases withstand acute upper gastrointestinal. Management of acute upper gastrointestinal bleeding. Mistakes in upper gastrointestinal bleeding and how to. Management of acute upper gastrointestinal bleeding the bmj. Risk of death lower with the restrictive strategy in all subgroups, except in childs class c cirrhosis similar rates.
Introduction ulcers are the most common cause of hospitalization for upper gastrointestinal bleeding ugib, and the vast majority of clinical trials of therapy for nonvariceal ugib focus on ulcer disease. Diagnosis 1 questions to ask in history any hematemesis, coffeeground emesis, melena, or hematochezia. Pdf management of acute upper gastrointestinal bleeding. Diagnosis and management of upper gastrointestinal bleeding. A service fee is charged by the payment partner, not ugi. Can be categorized as either variceal or nonvariceal. Acute upper gastrointestinal bleeding is a common medical emergency that has a 10% hospital mortality rate. The outcome for patients with variceal bleeding depends on achieving hemostasis and avoiding complications related to bleeding or underlying chronic liver disease. Upper gastrointestinal bleeding ugib is defined as bleeding derived from a source proximal to the ligament of treitz. However, proton pump inhibitors do not improve clinical outcomes such as further bleeding, surgery, or death. Management of nonvariceal upper gastrointestinal bleeding. Often, the location of the bleeding lesion in the upper gi tract is signaled by the patients presentation with hematemesis.
Offer a repeat endoscopy to patients who rebleed with a view to further endoscopic. Surgery education at the university of kansas school of medicine, kansas city, kansas administers the clerkship and courses in surgery and its specialties during the m3 and m4 years of medical school at the ku school of medicine, kansas city, campus. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool. Nice pathways are interactive and designed to be used online. Introduction upper gastrointestinal bleeding ugib is a poten. Definition upper gastrointestinal gi hemorrhage refers to hemorrhage in the upper gastrointestinal tract. Clinicalmanagement of acute upper gastrointestinal bleeding. Acute gastrointestinal bleeding is a potentially lifethreatening abdominal emergency that remains a common cause of hospitalization. Despite changes in management, mortality has not significantly improved over the past 50 years. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage. Predictive role of red cell distribution width in upper gi. This entity has an annual incidence of 48 to 160 cases per 100,000 adults 24, with a mortality rate of 10% to 14% 5. Upper gastrointestinal bleeding ugib is a common medical emergency, with a reported. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
The anatomic cutoff for upper gi bleeding is the ligament of treitz, which connects the fourth portion of the duodenum to the diaphragm near the splenic flexure of the colon. Variceal is a complication of end stage liver disease. Variceal bleeding is the cause of ugi bleeding in cirrhotics 59% of the time, followed by peptic ulcer disease in 16% of cases. Acute gastrointestinal bleeding is a common emergency. Sanders6, matthew kurien6, gianluca rotondano7, tomas hucl8, mario dinisribeiro9, riccardo marmo10, istvan racz11, alberto arezzo12. Find, read and cite all the research you need on researchgate. A free powerpoint ppt presentation displayed as a flash slide show on id. Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia. Upper gi ugi bleeding is generally defined as bleeding that occurs in the digestive tract proximal to the ligament of treitz. Management of upper gastrointestinal bleeding annals of internal. Pdf management of upper gastrointestinal bleed researchgate. It encompasses upper gastrointestinal bleeding such as from peptic ulcers and oesophageal varices 1 and lower gastrointestinal bleeding commonly from diverticular disease, colitis, and cancer. Mistakes in upper gastrointestinal bleeding and how to avoid them discover more about the most frequent mistakes. In 5 to 10 percent of patients with severe ugib, it may present as hematochezia.
This entity has an annual incidence of 48 to 160 cases per 100,000 adults, with a mortality. Acute upper gastrointestinal gi bleeding is a potentially lifethreatening condition requiring accurate, prompt, and appropriate patient evaluation and management. Clinicians of all specialties must know the best practices for preventing and managing upper gi bleeding. However, patients with active bleeding and hypovolemia may require blood transfusion despite an apparently normal. Upper gastrointestinal hemorrhage the word upper implies that the source of bleeding is in the esophagus, stomach or duodenum. Gastrointestinal bleeding gi bleed, also known as gastrointestinal hemorrhage gib, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. Gastrointestinal bleeding is a common problem encountered in the emergency department and in the primary care setting. Winner of the standing ovation award for best powerpoint templates from presentations magazine.
Listing a study does not mean it has been evaluated by the u. Management and prevention of upper gi bleeding accp. Design plans for the prevention of upper gi bleeding caused by commonly associated risk factors. Patients with idiopathic ulcers receive longterm antiulcer therapy. Predictive role of red cell distribution width in upper gi bleeding patients. Acute upper gastrointestinal bleed augib is one of the most common medical. An ebook reader can be a software application for use on a computer such as microsofts free reader application, or a booksized computer this is used solely as a reading device such. Acute uppergastrointestinal bleeding ugib is a commonly. It commonly presents with hematemesis vomiting of blood or coffee groundlike material andor melena black, tarry stools. Haematemesis, the passage of melaena andor firm clinical evidence and laboratory support for acute blood loss from the upper gastrointestinal ugi tract. Assessing upper gastrointestinal bleeding in adults.
Devise a plan to effectively manage acute gi bleeding and optimize treatment responses in the individual patient. See upper gastrointestinal bleeding for clinical treatment page. Variceal bleeding is a gastrointestinal emergency that is one of the major causes of death in patients with cirrhosis. 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. We therefore developed and validated a risk score to assess whether patients presenting with acute uppergastrointestinal bleeding will require. Dealing with upper gastrointestinal ugi bleeding is fraught with pitfalls, not least because spotting those patients who are suffering significant bleeding can be difficult amongst the majority of referrals who are ill and. Endoscopy is used for diagnosis and to provide therapy, prior to which the patient should be adequately resuscitated and assessed.
Rapid filling of the stomach with blood will usually result in emesis. A uk audit in 2007 found an overall mortality of 10%. For the majority of patients with acute upper gastrointestinal bleeding who do not have significant comorbid illnesses, we recommend giving blood transfusions to maintain the hemoglobin at. Discharge of patients with an acute upper gastrointestinal. Small amounts of bleeding over a long time may cause irondeficiency. Offer a repeat endoscopy to patients who rebleed with a view to. While non variceal bleeding associated with peptic ulcer disease or other causes of ugib. You may pay your ugi bill in person at one of the authorized checkfreepay locations.
Nonvariceal upper gastrointestinal bleeding ugib carries high morbidity and mortality, which can be lowered by timely evaluation and management. Ppt gastrointestinal bleeding powerpoint presentation. Approach to acute upper gastrointestinal bleeding in adults. Acute upper gastrointestinal bleeding overview nice pathways bring together everything nice says on a topic in an interactive flowchart. This article focuses on assessing and managing adults with acute. Restrictive strategies, which gave way to more liberal approaches for the greater part of the 20 th century, have again gained traction as emerging research suggests restricting transfusion is associated with similar, or possibly better outcomes in ugi bleeding.
The rates of ugib are higher in men and the elderly. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. Epidemiology of ugi bleeding accounts for 350,000 hospitalizations in u. Upper gastrointestinal bleeding ugib is a common medical condition that results in substantial morbidity, mortality, and medical care cost. A risk score to predict need for treatment for uppergastrointestinal haemorrhage. Gastrointestinal bleeding nice guideline draft november 2011. Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Patients with acute upper gastrointestinal gi bleeding commonly present. Department of surgery education, university of kansas. Gastrointestinal bleeding knowledge for medical students. Lower gastrointestinal bleeding lgib may occur in the colon. American college of gastroenterology guideline on the management of helicobacter pylori eradication. Blood transfusion practices for acute upper gastrointestinal hemorrhage have changed over time.
Diagnosis and management of nonvariceal upper gastrointestinal. Upper gastrointestinal bleeding ugib is the loss of blood through the gastrointestinal tract whose origin proximal to the treitz angle 1. Patients presenting with iron deficiency anaemia without evidence of acute upper gastrointestinal bleeding augib were excluded. Acute upper gi bleeding can present as variceal or nonvariceal bleeding and has a high death rate. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Causes of upper gastrointestinal bleeding in adults uptodate. Upper gastrointestinal bleeding ugib is a common medical emergency, with a reported mortality of 210%.370 250 1363 78 13 663 372 740 516 492 296 122 953 310 1451 669 495 179 2 726 1155 11 1117 162 1290 468 64 378 97 1045 913 925 6