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Gastrointestinal Bleeding, Emergency Medicine

Czarina E. Sá nchez and Leon D. Sá nchez Reviewed 06/2017
 


Basics

Description

  • Bleeding from GI tract:

    • Upper GI tract: Proximal to ligament of Treitz

    • Lower GI tract: Distal to ligament of Treitz to anus

  • Mortality rate:

    • 10% overall; from <5% in children up to 25%...

Diagnosis

Signs and Symptoms

  • Both UGIB and LGIB may present with signs/symptoms of hypovolemia

  • UGIB classic presentation:

    • Hematemesis or coffee ground emesis

    • Melena: Black tarry stool

  • LGIB classic presenta...

Treatment

Pre-Hospital

  • Stabilize airway

    • Intubate for massive UGIB, if patient unable to protect airway

  • Establish access

    • Insert large-bore IV (16–18g) and administer crystalloid to keep SBP >90 mm Hg

    • Att...

Follow-Up

Disposition

Admission Criteria

  • Active bleeding

  • Age >65 or comorbid conditions

  • Coagulopathy

  • Decreased hematocrit

  • Unstable vital signs at any time

Discharge Criteria

  • Resolution of UGIB with negativ...

Pearls and Pitfalls

  • 10–15% of UGIB present with hematochezia

  • Consider GIB in patients presenting with signs of hypovolemia or hypovolemic shock

  • Common pitfall: Failure to adequately resuscitate with cry...

Additional Reading

  • Das  AM, Sood  N, Hodgin  K, et al. Development of a triage protocol for patients presenting with gastrointestinal hemorrhage: A prospective cohort study. Crit Care.  2008;12:R...

Codes

ICD9

  • 533.40 Chronic or unspecified peptic ulcer of unspecified site with hemorrhage, without mention of obstruction

  • 535.51 Unspecified gastritis and gastroduodenitis, with hemorrhage

  • 578.9 Hemorrha...

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